Improving Post-procedural Ocular Surface Discomfort in Patients Receiving Regular Intraocular Injections.

Abstract

Purpose : Intravitreal injection of medications has revolutionized the treatment of retinal microvascular diseases. These diseases often require regular, life-long injections. Ensuring patient comfort is important for compliance with long-term treatments. Patients receiving regular intravitreal injections often complain of progressive dry-eye related discomfort. These symptoms are likely secondary to the use of povidone iodine as an antiseptic. We hypothesize that punctal plugs could reverse the progressive ocular surface discomfort induced by povidone iodine following intravitreal injections.

Methods : This is an observational case series conducted at a regional tertiary care retina clinic. Twenty seven patients receiving monthly intravitreal injections were assessed for the presence of ocular surface disease using the Ocular Surface Disease Index (OSDI). A total of 5 questionnaires were administered immediately before and 3 days after each intravitreal injection. Patients received an inferior punctal plug just prior to the second injection.

Results : At baseline, patients receiving monthly intravitreal injections, had elevated OSDI scores indicating dry eye disease (34.43±16.487). OSDI scores remained the same after first injection (35.34±19.36) with a percent difference of 2.56% (P=0.579). Following placement of the punctal plug OSDI scores (18.3±10.75) were reduced by 48.58% (P=0.0004). The OSDI remained low 3-5 days after injection in the presence of a punctal plug.

Conclusions : Patients receiving regular intravitreal injections have dry eye disease at baseline. Dry eye symptoms remain stable after intravitreal injection. Punctal plugs greatly reduce ocular surface discomfort in patients receiving monthly intravitreal injections.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.