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S. Trikha, S. Khandadia, C. Rennie, A. Lotery; The National Intravitreal Injection Questionnaire - A Snapshot of Current UK Clinical Practice. Invest. Ophthalmol. Vis. Sci. 2010;51(13):906.
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© ARVO (1962-2015); The Authors (2016-present)
To survey current UK clinical practice in the administration techniques of intravitreal Anti-VEGF agents for the treatment of age related macular degeneration (ARMD).
An electronic mail survey of Ophthalmologists practicing in National Health Service (NHS) units across the United Kingdom and Northern Ireland, and currently administering intravitreal anti-VEGF therapy for Age related Macular Degeneration, was conducted. Data was collated over a 4 week period
127 completed surveys were obtained across 69 Ophthalmology departments (98.4% response rate). 46.5% of responses were from Medical Retina subspecialists and over half of responders were Consultant Ophthalmologists. Most (79.2%) of responders issued patients written information before the procedure, and over two-thirds (68.6%) consented for a series of intravitreal injections, rather than separately.48.3% of responders used a dedicated treatment room for injections and 3.3% used the clinic room, but in total, 10.2% did not have resuscitation equipment on standby. 62.2% of responders did not administer a pre-injection antibiotic. Whilst all responders used povidone iodine, over half of doctors (54.8%) used this for less than 3 minutes prior to injection, and 2.5% did not use a speculum for the procedure. The vast majority (85.6%) of responders did use callipers to measure limbal distance for injection, although 60.2% of responders did not rotate the site of injection routinely. 17.8% did not use a sterile drape for the procedure, and 55.2% used sterile gloves only for administration.76.1% check ‘Hand movement’ vision after the procedure and 25.6% checked intraocular pressure routinely after the procedure. Whilst most (94.9%) administered antibiotics immediately after the procedure, a small proportion (5.9%) stated that they did not prescribe antibiotic drops immediately after the procedure. 48.6% of UK Ophthalmologists conduct injections using dedicated operating theatre lists, with 63.2% performing 7 or more injections per session.
Large national variations exist in the administration technique of intravitreal injections, with particular variations in the level of asepsis. Close correlation with multicentre analysis of infection and complication rates will lead to optimal administrative techniques, and possibly national guidelines, in the future.
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