Same-day bilateral intravitreal injections of anti-VEGF

Abstract

Purpose : Intravitreal injections are one of the most common ophthalmic procedures and bilateral injections are frequently necessary in clinical practice, since many retinal diseases requiring this treatment occur bilaterally. This study evaluated the outcomes and complications of bilateral same-day intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections.

Methods : This is a retrospective case series of 118 eyes of 59 patients who received concomitant bilateral intravitreal anti-VEGF injections in the office between September 2011 and November 2016. The medical records were reviewed for diagnosis, anti-VEGF agent used, pre and post injection visual acuity (VA) and intraocular pressure (IOP), post injection complications, newly developed systemic conditions throughout follow-up or any patient’s intolerance of simultaneous bilateral injections. All intravitreal injections had a separate povidone-iodine preparation, speculum, needle and syringe for each eye.

Results : A total of 1217 injections were performed bilaterally, with a mean of 20.63±12.56 injections per patient (range=2 to 56) throughout a follow-up period of 31.46±17.38 months. The indications for anti-VEGF therapy were especially wet age-related macular degeneration (83.1%) and diabetic macular edema (11.9%). Ranibizumab was the initiating anti-VEGF agent in 91.5% of the patients, aflibercept in 8.5% and none received bevacizumab. The mean logMAR VA pre and post bilateral treatment were minimally changed (0.65±0.59 and 0.64±0.62, respectively, p=0.819), as well as the pre and post IOP (15.28±3.07 and 14.90±3.68, respectively, p=0.189). However, 44.1% of the eyes required a total of 252 anterior chamber paracentesis (mean per eye= 4.85±3.99, range=1 to 19) at the moment of intravitreal injection due to an acute IOP rise. One patient had a mild vitreous hemorrhage not explained by the underlying ocular disease. Only one patient called the office complaining of a painless subconjunctival hemorrhage. No cases of endophthalmitis, ocular inflammation, retinal tear, retinal detachment or systemic side effects were identified. No patients requested to switch to alternating unilateral injections.

Conclusions : Same-day bilateral intravitreal anti-VEGF injections are safe and well tolerated by patients. Evidence of its good acceptance and safety profile is important on supporting the use of this strategy, which may help reduce the treatment burden experienced by these patients.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.