# Situation: A 49-year-old woman has had type 2 diabetes mellitus for 12 years and hypertension for 8 years. A dilated eye examination shows proliferative diabetic retinopathy in both eyes. Diabetic macular edema in the left eye is treated with an intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection. When the nurse calls her the next day, which finding is expected?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630541  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 49-year-old woman has had type 2 diabetes mellitus for 12 years and hypertension for 8 years. A dilated eye examination shows proliferative diabetic retinopathy in both eyes.

Diabetic macular edema in the left eye is treated with an intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection. When the nurse calls her the next day, which finding is expected?

## 보기

1. Central vision dimmer than it was before the injection
2. A small red patch on the white of the eye at the site **✔ 정답**
3. Redness of the whole eye with a yellowish discharge
4. Eye pain that is worse than on the day of injection

**정답: 2**

## 해설

After an intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection, a scratchy feeling or a small red spot on the white of the eye at the injection site is expected. Increasing pain, worsening vision, spreading redness or discharge in the days after the injection suggests endophthalmitis and must be reported.

## 심화 해설

What anti-VEGF injection does
Diabetic macular edema is swelling of the macula, the central part of the retina, caused by leaky vessels. Vascular endothelial growth factor (VEGF) promotes both leakage and new vessel growth. An intravitreal anti-VEGF injection delivers a drug directly into the vitreous through the white of the eye to block VEGF, reduce swelling, and improve or preserve central vision. Injections are often given repeatedly over months.

The expected finding
A small red patch on the white of the eye at the injection site, a subconjunctival hemorrhage, is common and harmless after an intravitreal injection. It comes from a tiny surface vessel broken by the needle and fades over one to two weeks. A mild scratchy or gritty feeling for a day, often from the antiseptic used to prepare the eye, is also expected. The nurse reassures the client that this patch does not affect vision and needs no treatment.

Warning signs of endophthalmitis
The most serious complication is endophthalmitis, an infection inside the eye that can destroy vision within hours to days. Its signs are increasing eye pain, worsening vision, spreading redness of the whole eye, discharge, and light sensitivity, typically appearing in the first days after injection. Raised eye pressure and retinal detachment are other complications. Any of these must be reported the same day.

| Finding after injection | Expected? | Action |
| --- | --- | --- |
| Small red patch at the site | Yes | Reassure |
| Mild scratchy feeling | Yes | Reassure; lubricating drops if ordered |
| Dimmer central vision | No | Report the same day |
| Whole-eye redness with yellowish discharge | No | Report the same day |
| Pain worse than on injection day | No | Report the same day |

Why the other findings must be reported
Central vision dimmer than before the injection, redness of the whole eye with yellowish discharge, and pain that is worse than on the day of injection are each a warning sign of infection or raised pressure. They are the opposite of the expected course, in which comfort improves day by day. Even with a mild-looking symptom, the safer path is same-day review because early treatment of endophthalmitis protects vision.

Exam takeaway
Key point After an intravitreal injection, a small red spot at the site is expected. Increasing pain, worsening vision, spreading redness, or discharge suggests endophthalmitis and is reported at once.

## 임상 시나리오

After an Intravitreal Anti-VEGF InjectionExpected versus warning findings
An anti-VEGF injection into the vitreous reduces leakage and swelling in diabetic macular edema.

A small red patch on the white of the eye at the site and a mild scratchy feeling are expected and harmless.

Teach her to report increasing pain, worsening vision, spreading redness, discharge, or light sensitivity the same day.

CautionThese warning signs suggest endophthalmitis, an infection that can destroy vision quickly. Do not wait for the next scheduled visit.

## 핵심 개념

- **Anti-VEGF injection** — An injection into the eye that blocks vascular endothelial growth factor to reduce leakage and new vessel growth.
- **Diabetic macular edema** — Swelling of the central retina from leaky vessels in diabetes, reducing central vision.
- **Subconjunctival hemorrhage** — A harmless red patch on the white of the eye from a broken surface blood vessel.
- **Endophthalmitis** — Serious infection inside the eye causing pain, redness, discharge, and vision loss.

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