Issn Print: 0275-004X

Publication Date: 2004/10/01


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Intravitreal Injections: The Route of Retinal Pharmacotherapies

Harry W. Flynn; Ingrid U. Scott

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Excerpt

The optimal techniques for intravitreal injections are in a state of evolution. At the current time, limited publications report the technique of, and visual outcomes following, intravitreal injection of retinal pharmacotherapies. In view of the increasing use of intravitreal injections in the management of posterior segment diseases, a group of experienced investigators met to create a document which presents “best practices” recommendations in an attempt to minimize complications and optimize outcomes following intravitreal injections of retinal pharmacotherapies. Representatives from pharmaceutical companies based in the United States and known to be involved in the research and development of retinal pharmacotherapies administered via intravitreal injection were invited to attend this meeting, which was sponsored by an unrestricted educational grant from Eyetech/Pfizer Ophthalmics, New York, USA. As the results of ongoing randomized controlled clinical trials involving intravitreal injections are analyzed and published, these recommendations are expected to evolve as more experience with intravitreal injections is gained.
The guidelines proposed in the current issue of RETINA® can provide the practicing vitreoretinal physician with a plan, some parts of which had consensus agreement (use povidone iodine, use a lid speculum, avoid extensive massage of eyelids, avoid injecting patients with active eyelid or ocular adnexal infection, dilate the pupil, use adequate anesthetic, and avoid prophylactic or post-injection paracentesis) and other parts had less agreement (most of the investigators preferred povidone iodine drops over flush, most did not use a sterile drape, most advocated use of gloves, no agreement on use of pre- or post-injection topical antibiotics, no agreement on a specific intraocular pressure level at which physicians are comfortable discharging the patient, no consensus on when to see patient back for follow-up). The authors hope that the guidelines and discussion provided in this document will focus attention on technique-related issues which may may translate into fewer injection-related complications and thereby optimize outcomes.
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