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Stephen J Smith, Therese Sassalos, Nish Patel, Chris Andrews, David C Musch, Cagri G Besirli; Survey of Intravitreal Injection Practice Patterns among Retina Specialists. Invest. Ophthalmol. Vis. Sci. 2019;60(9):109.
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© ARVO (1962-2015); The Authors (2016-present)
Intravitreal injection therapy (IVT) is the most commonly performed procedure in ophthalmology. There are comparatively few data to guide selection of best practice patterns to deliver intravitreal therapies. This study was conducted with the aim of determining current trends in IVT delivery among retina specialists.
An online, 31-question, multiple-choice survey was created using the Qualtrics interface (Provo, UT) and sent to 1677 retina specialists. The survey consisted of 3 sections: general questions, procedure technique, and post-procedure technique. Results were tabulated, and the data were analyzed using the Qualtrics platform. Statistical analysis was performed in SAS.
A total of 264 retina specialists completed the survey (16%). 70% of respondents work in private practice, with most giving injections during their regular clinic. 60% of respondents give 20 or more injections in a typical day, and 69% reported giving bilateral, same day injections. The majority use an assistant to aid in injection preparation. 75% of respondents use an eyelid speculum, and 97% prefer a 30G or 32G needle for IVT delivery. Lidocaine gel is the most frequently used IVT anesthesia (31%), followed by subconjunctival lidocaine (28%). Most respondents (52%) wait 5-10 or 10+ minutes for their anesthetic of choice to take effect. 74% of respondents have patients request a different or supplemental form of anesthesia. All respondents use povidone-iodine for antisepsis, and 54% wait 30 seconds or more after the last povidone-iodine application to administer IVT. Approximately 33% reported receiving patient calls (frequently, 3%; sometimes, 30%) 24-48 hours post-IVT due to pain or foreign body sensation. Corneal toxicity was felt to be primarily responsible for post-IVT pain (76%) and 84% believe Betadine contributes to post-IVT corneal toxicity. Needlestick injuries were reported to occur to 10% of physicians and 3% of assistants.
There is consensus on a few aspects of IVT delivery including the use of povidone-iodine, eyelid speculum, and small gauge needle. Most respondents report the occurrence of post-IVT pain in at least some patients, attributed to povidone-iodine-induced corneal toxicity. There is a lack of consensus on ocular anesthesia choice, with most practitioners having at least some patients request other options. Needlestick injuries are a common occurrence for physicians delivering IVT.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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