Comparing the Effects of Three Different Intravitreal Injection Techniques on Vitreous Reflux and Intraocular Pressure

Özkaya, Abdullah; Alkın, Zeynep; Çelik, Uğur; Yüksel, Kemal; Ozgurhan, Engin Bilge; Ağca, Alper; Yazıcı, Ahmet; Demirok, Ahmet

doi:10.1089/jop.2012.0144

Cited by 29 publications

(27 citation statements)

References 25 publications

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“…In other studies, the subconjunctival reflux occurred in between 17 [18] and 38% [19] of the eyes. The presence of a subconjunctival reflux depended on the intravitreal injection technique (in order of decreasing reflux rate: straight, oblique and double-plane tunnel scleral [20] ) and on the diameter of the needle (30 G causes less reflux than 27 G, particularly when the injection is not beveled [21] ). Since the injected dose and volume of the drug as well as the injection technique and needle diameter were the same in all cases, it is unlikely that these variables were the cause of the IOP elevation.…”

Section: Resultsmentioning

confidence: 99%

Intraocular Pressure in Eyes Receiving Intravitreal Antivascular Endothelial Growth Factor Injections

et al. 2015

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between pre-and postoperative measurements (p < 0.05). Subconjunctival reflux was recorded in 11.3%, and in this subgroup the IOP at 5 min and at 1 h was lower than preoperative IOP (p < 0.05). Conclusions: More than one third of the eyes achieved IOPs >30 mm Hg 5 min after injection. Subconjunctival reflux contributed to a lower mean postoperative IOP (p < 0.05). Considerations for the management include prophylactic IOP lowering with medical therapy and/or preinjection ocular decompression for patients with a history of glaucoma or ocular hypertension and switching to an as-needed injection protocol in patients suffering a marked IOP rise in previous injections.

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Section: Resultsmentioning

confidence: 99%

Intraocular Pressure in Eyes Receiving Intravitreal Antivascular Endothelial Growth Factor Injections

et al. 2015

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“…Several studies have demonstrated that smaller bore needles have less postinjection reflux and a higher IOP. 50,69,87,88 Similarly, tunneled injection techniques allow the needle track to be pinched off by the edge of the sclera, reducing the amount of reflux and increasing post-injection IOP. 69,87 A second important risk factor for severe, acute ocular hypertension and delayed recovery is a prior history of glaucoma.…”

Section: Bmentioning

confidence: 99%

“…50,69,87,88 Similarly, tunneled injection techniques allow the needle track to be pinched off by the edge of the sclera, reducing the amount of reflux and increasing post-injection IOP. 69,87 A second important risk factor for severe, acute ocular hypertension and delayed recovery is a prior history of glaucoma. 10,66 Bakri et al found that 10 minutes after IVI of bevacizumab, triamcinolone, or pegaptanib, only 75% of glaucomatous patients recovered to an IOP of less than 35 mmHg in contrast with 95.5% of patients without glaucoma.…”

Section: Bmentioning

confidence: 99%

The acute and chronic effects of intravitreal anti-vascular endothelial growth factor injections on intraocular pressure: A review

Bracha

Moore

Ciulla

et al. 2018

Survey of Ophthalmology

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The acute and chronic effects of repeated intravitreal antivascular endothelial growth factor (VEGF) injections on intraocular pressure have not been fully characterized, and the development of sustained ocular hypertension could adversely affect patients who are at risk of glaucomatous optic neuropathy. As expected, volume-driven, acute ocular hypertension immediately follows intravitreal injection, but this pressure elevation is generally transient and well tolerated. Several medications have been investigated to limit acute ocular hypertension following anti-VEGF therapy, but the benefits of pretreatment are not conclusive. Chronic, sustained ocular hypertension, distinct from the short-term acute ocular hypertension after each injection, has also been associated with repeated intravitreal anti-VEGF injections. Risk factors for chronic ocular hypertension include the total number of injections, a greater frequency of injection, and preexisting glaucoma. Proposed mechanisms for chronic ocular hypertension include microparticle obstruction, toxic or inflammatory effects on trabecular meshwork, as well as alterations in outflow facility by anti-VEGF agents. Although limiting anti-VEGF therapy could minimize the risk of both acute and chronic ocular hypertension, foregoing anti-VEGF therapy risks progression of various macular diseases with resulting permanent central vision loss. While definitive evidence of damage to the retinal nerve fiber layer is lacking, patients receiving repeated injections should be monitored for ocular hypertension and patients in whom sustained ocular hypertension subsequently developed should be periodically monitored for glaucomatous changes with optic nerve optical coherence tomography and static visual fields.

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“…Tunneled injections through the sclera are associated with less vitreous reflux compared with straight injections that enter the sclera perpendicularly [178–180]. The most commonly used needle size for anti-VEGF injections is 30G [48].…”

Section: Reviewmentioning

confidence: 99%

“…The reduced vitreous reflux with 32G needles or tunneled injections is associated with a higher immediate, though transient, intraocular pressure (IOP) elevation [179, 180, 184, 185]. Hoang et al [184] have reported that repeated intravitreal injections in an eye may be complicated by sustained elevations in IOP.…”

Section: Reviewmentioning

confidence: 99%

Endophthalmitis following intravitreal anti-vascular endothelial growth factor (VEGF) injection: a comprehensive review

Merani

Hunyor

2015

Int J Retin Vitr

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The purpose of this review is to report and summarize previously reported studies and assess many of the individual steps of the intravitreal injection procedure’s possible effect on the prevention of endophthalmitis. The pooled endophthalmitis rate from 20 large retrospective case series of anti-VEGF injections was 144/510,396 (0.028%; 1/3,544). Injections may be performed in an office-based location or in an operating room (OR) and low rates of endophthalmitis can be achieved in either location with careful attention to asepsis. Pre- or post-injection topical antibiotics have not been shown to be effective, and could select for more virulent microorganisms. Povidone-iodine prior to injection is accepted as the gold-standard antiseptic agent, but aqueous chlorhexidine may be an alternative. Antisepsis before and after gel or subconjunctival anesthetic is suggested. The preponderance of Streptococcal infections after intravitreal injection is discussed, including the possible role of aerosolization, which can be minimized by using face masks or maintaining silence. As with other invasive procedures in medicine, the use of sterile gloves, following adequate hand antisepsis, may be considered. Control of the eyelashes and lid margin is required to avoid contamination of the needle, but this can be achieved with or without a speculum. Techniques to minimize vitreous reflux have not been shown to reduce the risk of endophthalmitis. Same day bilateral injections should be performed as two separate procedures, preferably using drug from different lots, especially when using compounded drugs.

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Comparing the Effects of Three Different Intravitreal Injection Techniques on Vitreous Reflux and Intraocular Pressure

Abstract: Double-plane tunnel injection prevents VR from the injection site and has no additional complications than other techniques.

Cited by 29 publications

References 25 publications

Intraocular Pressure in Eyes Receiving Intravitreal Antivascular Endothelial Growth Factor Injections

Intraocular Pressure in Eyes Receiving Intravitreal Antivascular Endothelial Growth Factor Injections

The acute and chronic effects of intravitreal anti-vascular endothelial growth factor injections on intraocular pressure: A review

Endophthalmitis following intravitreal anti-vascular endothelial growth factor (VEGF) injection: a comprehensive review

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