Intravitreal Injection Survey

Anti-infection procedures are still evolving

Intravitreal Injection Survey
Anti-infection procedures are still evolving.

Almost all of the emerging therapies for the wet form of AMD are currently administered by intravitreal injection, including pegaptanib sodium (Macugen, OSI/Eyetech, Pfizer), bevacizumab (Avastin, Genentech), ranibizumab (Lucentis, Genentech) and triamcinolone (Kenalog, generic). With retina specialists now routinely using 1 or more of these drugs in everyday practice, the editors of Retinal Physician thought it timely to conduct a survey to determine how doctors are performing intravitreal injections, how closely they are following various recommendations for infection control, and what types of complications they are seeing, if any.

In regard to anti-infection protocols, OSI/Eyetech recommends that patients receive ophthalmic antibiotic drops for 3 days prior to a pegaptanib sodium injection, or a 10 ml povidine-iodine flush just before the injection is given. Some retina specialists who have had extensive experience with intravitreal injections believe that a combination of both the antibiotic and the povidine flush provide the best protection against infection. Other doctors also recommend antibiotics, usually a fourth-generation fluoroquinolone such as gatifloxacin (Zymar, Allergan) or moxifloxacin (Vigamox, Alcon), but administered both preoperatively and postoperatively.

The following are the results of a 6-question survey conducted by Retinal Physician in March 2006, and which include responses from 51 retina specialists. Part 2 of this survey will appear in the July/August issue of Retinal Physician and will provide data on complication management and vision loss from complications.

1. Percentage of overall intravitreal injections performed – by specific drug (individual responses tabulated and averaged to total 100%)

Triamcinolone (Kenalog)            41.4%
bevacizumab (Avastin)              26.5%
pegaptanib sodium (Macugen)   24.5%
ranibizumab (Lucentis)                4.5%
other (usually antibiotics)             3.1%

2. Do you use antibiotics prior to injection? If yes, how many days prior to the injection are you using antibiotics?

Yes 29


Number of days pre-injection:

3 days        (16)
same day     (7)
3-4 days       (2)
1 day           (2)
1-3 days      (1)
2 days         (1)
No 22

3. Do you use antibiotics post-injection? If yes, what is your post-injection regimen for antibiotics?

Yes 48
Number of days post-injection:

3 days    (14)
4 days    (11)
5 days    (10)
7 days     (6)
3-5 days  (3)
2 days     (3)
5-7 days  (1)
No 3


4. Do you use anesthetics prior to injection?

Yes 50  98.04%
No 1     1.96%

5. If Yes, what type of anesthesia do you use:

Topical              34 66.6%
Subconjunctival 17 33.3%

6. What types of complications have you experienced with intravitreal injections?

Kenalog-related elevated IOP (13)
Endophthalmitis (12)
Subconjunctival hemorrhage (7)
Kenalog-related lens opacity (4)
Floaters (4)
Pain/discomfort (2)
Kenalog-related uveitis (1)
Vitreous hemorrhage (1)
Retinal detachment (1)
Corneal abrasion (1)
Subretinal hemorrhage (1)
Subconjunctival bleb (1)
Loss of spontaneous CRA pulsation (1)
No complications (14)