In-Office Procedures

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In-Office Procedures

Intravitreal Injections

• What to Expect Post Intravitreal Injection

  24-48 Hour Post-Injection Expectations
  In the hours after your intravitreal injection your eye may feel “gritty”, like you have dirt or sand in it, and you may experience some tearing, mild soreness, burning, and/or irritation. Your doctor may apply an antibiotic ointment immediately after the procedure to alleviate symptoms. After 24-hours, symptoms should be 50-70% resolved and almost fully back to normal within 48-hours.

  The eye patch applied to your eye should be kept on temporarily for 2-3 hours post-procedure to avoid abrasion or accidental rubbing, and to keep the ointment on if we applied it. Once the patch is self-removed you can use an over-the-counter lubricant eye ointment and/or artificial tear drops to soothe your eye.

  Your retina specialist may check your intraocular pressure (IOP) following the injection. There is a temporary rise that usually returns to baseline in a few minutes. The IOP may take longer to normalize in patients with glaucoma and needs to be monitored.

  Other Normal Symptoms

  • Floaters: drifting spots or specs in your vision; black, gray, or transparent strings, shadows, or cobwebs. These floaters are usually tiny air bubbles the syringe creates that are impossible to eliminate, even in the most experienced hands.
  • A localized red spot or patch on the surface of the eye. This is where the needle punctured a blood vessel causing a small bleed or subconjunctival hemorrhage; this usually heals within a week.

• What Should You Avoid Post-Injection

  • DON’T rub your injected eye.
  • DON’T wash your face or shower for 48-hours.
  • DON’T swim the week following.
  • DON’T miss your follow-up appointment(s).
  • DON’T wear contacts for the rest of the day.

• What You Can or Should Do Post-Injection

  • Follow your physician’s specific instructions for follow-up injections or course of injections.
  • You may continue to use your regular over the counter or prescription eye drops as needed. We suggest using a fresh bottle of drops for the injected eye to avoid infection.
  • Usually there are few, if any, physical restrictions. Please, consult your doctor to confirm.

• Complications & Risks

  Severe complications are very rare with intravitreal injections. If any of the following conditions occur after 48-hours, please contact our triage team as soon as possible, as these can be warning signs of a complication:

  • Sensitivity to light
  • Significant eye pain or swelling
  • Blurred vision or reduction in sight
  • A bright red eye
  • Floaters or flashes that are getting worse or a dark shadow or curtain from above or below
  • A rare but important warning sign is a milk-like fluid level in front of your iris.

  The major risks are:

  • Infection in the eye or endophthalmitis
  • Inflammation in the eye or pseudoendophthalmitis (a non-infectious, inflammatory reaction to some medications)
  • Bleeding into the vitreous gel (vitreous hemorrhage)
  • Retinal detachment

• My eye is bleeding, is this normal?

  The answer is yes, you’re OK! After an injection, it is normal to develop what is called subconjunctival hemorrhage, a red spot that develops on the white of the eye. This type off hemorrhage is essentially a painless bruise in the eye. You may not know you have it until you look in the mirror.

  Subconjunctival hemorrhages can be caused by something as simple as a sneeze or rubbing your eye. Briefly, your blood pressure spikes in your veins and can cause capillaries to break. Rarely, subconjunctival hemorrhage is caused by a blood clot or other underlying issue.

  A subconjunctival hemorrhage heals on its own without treatment, within a few days to a few weeks depending on the size of the “bruise”.
  If your eye feels irritated, you may use artificial tears to alleviate the pain.

  Below is an example of a subconjunctival hemorrhage:

Retinal Laser Treatment

• What is retinal laser procedure?

  A retinal laser is a concentrated, high-energy beam of light that passes through the cornea and lens (non-retinal tissue) without damaging them, focusing very precisely on diseased tissue in the back (posterior segment) of the eye. These types of lasers are different from those used in refractive surgery, such as LASIK or PRK.

  Retinal laser photocoagulation is an in-office procedure used to treat several retinal conditions, including retinal tears, diabetic retinopathy, macular edema, and retinal vein occlusion. It is most frequently used to seal a retinal tear to prevent development of a retinal detachment. A retinal laser is also used to treat conditions involving abnormal blood vessels to prevent further retinal damage and preserve sight

• How to prepare for laser treatment

  • Because your eye(s) will be dilated, you may want to arrange for someone to drive you home.
  • Take your previously prescribed eye drops, supplements, and medications as usual.
  • You can eat and drink as usual before treatment. No need to fast.
  • Bring a dark pair of UV-blocking sunglasses to wear after treatment.

• How a laser treats an ocular condition

  The laser works by creating small areas of scar tissue that can seal off a tear or leaking blood vessels. It can also slow the growth of abnormal blood vessels (neovascularization) in the eye. The procedure cannot restore vision that is already lost, but it can significantly reduce your risk of experiencing future vision loss.

• What to expect during treatment

  This is a non-invasive medical procedure performed in the comfort of our office. During this procedure you will be awake. To begin, your doctor or technician will typically administer medicated eye drops to dilate your pupils, allowing for a better view of the retina. Dilation takes approximately 20-30 minutes.

  Topical anesthetic (numbing drops) is then placed in the eye to minimize discomfort during the procedure. If a microscope is used, specialized contact lenses will be placed on the eye to hold the eyelids open and visualize the areas indicated for treatment. In many cases, you will be positioned so you're lying flat in a reclined position. The laser will be focused on the retina to deliver the specific type of treatment required.

  During the laser procedure you will see bright green flashes of light and you may experience mild discomfort. Most patients’ find the bright lights are more uncomfortable than the actual energy from the laser. You may see hues of pink and purple. It may feel like you walked out of a dark movie theater into a very sunny day. Sometimes patients will feel slight pressure on the eyelids as the physician highlights critical areas for treatment.

  Length of the treatment varies but is usually completed in under 30 minutes. Please tell your doctor if you need a break during your treatment. Rarely, patients do not tolerate treatment in clinic and the procedure is rescheduled in the operating room so the patient can be placed under anesthesia.

• What to expect post-treatment

  Your vision may be blanched out (dark) for a few minutes after the procedure and you may see various colors in the pink/red spectrum. It is normal to experience blurred vision immediately after and up to a few hours post-procedure. Your eyes will be light sensitive for up to 4-6 hours due to dilation. Some patients may remain dilated for up to 24 hours, depending on the variable sensitivities to dilation drops. Sunglasses are recommended, especially outdoors. You may experience aching inside or around the eye, itching, teary or watery eyes, and/or hazy vision. Symptoms should resolve themselves within the next few days and recovery is accelerated by using over-the-counter artificial tears to lubricate the treated eye(s).

  Usually, it takes 1-2 weeks for the laser to mature. During this time, your doctor may advise a brief period of limited activity before resuming your normal activities.

  If you experience pain or discomfort post-procedure, take an over-the-counter pain medication, as instructed by your doctor, and administer ample artificial tears. Be sure to refrain from rubbing your eyes after the procedure. Typically, contact lenses can be safely worn the day following the procedure. In most cases, you can return to work the next day.

• Do I need a follow-up appointment?

  You will be asked to return for a follow-up visit with your physician to ensure your eyes are healing correctly and no infection is present. Your doctor will let you know when you need to return based on your condition.

• Will I need more than one laser treatment?

  That depends. Sometimes it can take weeks to months before your physician can determine how successful your laser treatment has been. Many patients do require more than one treatment to manage their eye condition and to prevent further deterioration of their vision.

• When to call our office

  Symptoms should gradually improve in the weeks following treatment. Generally, treatment for retinal tears will not result in more rapid resolution of symptomatic floaters or flashes noted before treatment as the purpose of laser is to precent vision loss from a detached retina. If at any time you have a sudden burst of new or worsening floaters or flashing lights, sudden decrease or change in vision clarity, experience peripheral shadows, resembling a curtain or veil, signs of an eye infection, or any pain or discomfort not alleviated with OTC pain medication or artificial tears, please call our office immediately at 303-261-1600 x2100 - follow the prompts to leave a message for ‘triage’. Someone will call you back shortly. For ocular emergencies, we have a Colorado Retina surgeon on-call afterhours, weekends, and holidays.

Cryotherapy

• What is cryotherapy?

  Cryotherapy or cryopexy is a means of freezing the area of the retina where a retinal tear has occurred. It is a procedure that uses intense cold to induce a retinal scar around the tear. The scar acts as a kind of glue to heal the tear in the retina. It then takes around 10 to 14 days to heal. Early detection of retinal tears is crucial to the success rate of the procedure. If left untreated, a retinal detachment may occur.

  Your CRA physician will decide which procedure, laser or cryotherapy is the right option to treat your retinal condition.

• What should I expect after cryotherapy?

  Cryotherapy is a same day procedure performed in a clinical setting in our office. First, a topical anesthetic will be placed on your eye, followed by a subconjunctival injection (under the eye or lid) of a local anesthetic. A tool called a cryo probe is then placed on the outside of the eye over the area of the retinal tear. The probe is turned on and a small area of the eye is frozen in a few seconds. Several areas will need to be frozen to seal the tear.

  You may experience a brief sensation like having an “ice cream headache” or “brain freeze”, but the procedure is painless and usually takes no longer than 10 minutes to complete.

• What to expect post-procedure

  • This is an outpatient procedure, so you go home the same day.
  • Your procedure eye will be patched at or office. That patch should remain on for a few hours to avoid rubbing and debris.
  • After the procedure is performed, mild redness, swelling, dry eye, and/or discomfort can be expected. You may take an over-the-counter pain reliever, acetaminophen (Tylenol) is recommended.
  • Changes in vision clarity, as well as halos, starbursts and glares when looking directly at light are also normal.
  • Healing will occur within 10–14 days. Vision may be blurred briefly, and the repaired eye is usually red and swollen for a short period of time.
  • Once the patch is removed you may lightly use a cold compress on your eyelid to alleviate discomfort.

• What are the expected results?

  Early treatment is key to the effectiveness of cryotherapy, and the procedure almost always improves vision quality. In retinal tears and detachments, the retina can be repaired and reattached in most cases. Some patients may need additional cryotherapy procedures when there is extensive retinal damage.

• When to call our office

  Following cryotherapy, if you experience a black curtain in your field of vision, complete or rapid loss of vision, or increase in spots/floaters, strands, or cobwebs, please call our office at (303) 261-1600 immediately and follow the prompts to speak with a member of our triage team.