Effect of Syringe Design on the Accuracy and Precision of Intravitreal Injections of Anti-VEGF Agents

Moisseiev, Elad; Rudell, Jolene C.; Tieu, Eric; Yiu, Glenn

doi:10.1080/02713683.2016.1276195

Cited by 18 publications

(13 citation statements)

References 11 publications

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“…Still, the chosen method is comparable to the clinical setting; drugs must be withdrawn from the vial in order to be injected into the eye, irrespective of whether the label recommendations or pharmaceutical compounding is utilized. A limitation of the current method itself is that the plunger resistance is altered 38,39 . For the 1.0 mL Injekt-F syringe used in the present study, there were only minimal dose variations.…”

Section: Discussionmentioning

confidence: 99%

“…For the 1.0 mL Injekt-F syringe used in the present study, there were only minimal dose variations. Yet, previous studies have shown highly variable accuracy and reproducibility when utilizing syringes that are commonly used for intravitreal injections 39–42 . Thus, a silicone oil-free syringe with a lower volume specifically manufactured for intravitreal use could further improve the current method.…”

Section: Discussionmentioning

confidence: 99%

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A new method for pharmaceutical compounding and storage of anti-VEGF biologics for intravitreal use in silicone oil-free prefilled plastic syringes

Lode

Gjølberg

Foss

et al. 2019

Sci Rep

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Intravitreal injections of antibody-based biologics targeting vascular endothelial growth factor (VEGF) are highly effective and have markedly decreased the risk of visual impairment associated with prevalent retinal diseases, such as neovascular age-related macular degeneration and diabetes macular oedema. The diseases are chronic in their nature, and most patients need long-term therapy to suppress disease activity. We previously reported a compounding method for repackaging and storage of aflibercept (Eylea), a commonly used anti-VEGF biologic, in silicone oil-coated plastic syringes without compromising drug stability or activity. In addition to improving safety and time spent per patient, compounding of anti-VEGF biologics enables single-dose vials to be split into multiple syringes, thereby considerably reducing waste and drug expenses. However, symptomatic silicone oil droplets may deposit in the eye’s vitreous body after repetitive injections. To fully avoid this complication, we here report on a novel pharmaceutical compounding method using silicone oil-free syringes and a 33 G × 9 mm Low Dead Space Needle hub injection needle. We evaluate the method for three anti-VEGF biologics commonly used in ophthalmology: aflibercept, ranibizumab (Lucentis) and bevacizumab (Avastin). Our results show that compounding and storage for one week does not compromise the functional activity of the biologics and allows for safe and cost-effective compounding of anti-VEGF biologics for intravitreal injections in prefilled silicone oil-free syringes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A new method for pharmaceutical compounding and storage of anti-VEGF biologics for intravitreal use in silicone oil-free prefilled plastic syringes

Lode

Gjølberg

Foss

et al. 2019

Sci Rep

View full text Add to dashboard Cite

show abstract

“…Moisseiev et al were able to demonstrate that different types of syringes, despite having the same labelling, deliver different volumes and thus deviate significantly from the values that the surgeon would like to administer during the injection. 52 The three syringe models tested in this study injected a significantly higher volume than the intended 50 μL. In the study described, the syringe design with low dead space showed the highest reproducibility of the delivered volume.…”

Section: Options To Reduce Contamination and Side Effectsmentioning

confidence: 75%

<p>Issues with Intravitreal Administration of Anti-VEGF Drugs</p>

Schargus¹,

Фрингс²

2020

OPTH

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Purpose: To provide an update of summary of risk factors and side effects of long-term use and contamination of intravitreal anti-VEGF injections. Methods: We reviewed relevant publications of the topic of contamination of anti-VEGF injections and long-term side effects due to this reason. Results: Due to the long-term use of anti-VEGF drugs and the higher number of injections worldwide, various studies have shown side effects in recent years, ranging from increased intraocular pressure to visual disturbing silicone oil vesicles in the vitreous cavity. Several studies have demonstrated that both the drug and the processing, storage, environmental factors and the material and design of the syringes have a decisive influence on these side effects.Conclusion: The risks of deposits from syringes in the eye can be significantly reduced by various optimizations in transport, storage and syringe and cannula selection.

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“…In a study by Moisseiev et al, 11 100 to 150 μL fluid was pulled into the injectors for IVI, the plunger was pressed up to the 50 μL line, and the fluid was ejected. The mean amount of the ejected fluid was found to be 58.0 ± 5.7 μL (a range of 44.1–70.2 μL) in 1 mL of tuberculin injectors.…”

Section: Discussionmentioning

confidence: 99%

“…1,7–10 Due to the lack of availability of specific injectors or prefilled ones, 1 cc insulin injectors are generally used in intravitreal injection procedures. 11 The doses of the drugs given in IVI may not be the intended doses. Significant deflections were reported in accuracy, sensitivity, and repeatability of the dose because of the administration of small volumes using relatively large injectors in IVI.…”

Section: Introductionmentioning

confidence: 99%

The influence of dead spaces and the designs of injectors on the amount of drug dose in intra-vitreal injection

Havuz

Havuz²,

Gökmen

2020

European Journal of Ophthalmology

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Aim: To evaluate the dead spaces resulting from different designs of the insulin injectors used for intravitreal injections and the amounts of drug doses. Methods: In the study, five different brands of sterile insulin injectors of 1 mL were used for the test. The weight of the injectors was determined before and after filling the injectors with 0.05 and 0.1 mL distilled water. The weight of the injectors was measured with and without the needle after the water within the injectors had been taken out and weight differences were measured. The difference between the intended amount of fluid to be thrown out and the weight of the fluid remaining in the injector was calculated as percent error. Results: After throwing out 0.05 mL distilled water from the injector, weights of the Beybi®, Traf®, Becton Dickinson®, Ayset®, and Setojet® brands of injectors with 30 G needle were detected to increase the mean 0.0220 ± 0.006 g, 0.0208 ± 0.008 g, 0.0355 ± 0.016 g, 0.0219 ± 0.017 g, and 0.0150 ± 0.007 g, respectively compared to the weights of the dry injectors. The 0.1 mL injector group was found to be mean 0.0350 ± 0.014 g, 0.0264 ± 0.008 g, 0.0405 ± 0.015 g, 0.0272 ± 0.013 g, and 0.0245 ± 0.014 g, respectively. The maximum increase due to the dead spaces in the injectors was found in the Becton Dickinson® injector, both in the 0.05 mL and the 0.1 mL groups ( p < 0.000). Conclusion: The injector designs may affect the dose of IVI required to be given. More correct amounts of drugs may be administered via the intra-vitreal route through designs that reduce the dead spaces at the end part of the injector and between the inner wall and the plunger.

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Effect of Syringe Design on the Accuracy and Precision of Intravitreal Injections of Anti-VEGF Agents

Abstract: Intravitreal injections of anti-VEGF agents using a 1.0 mL tuberculin syringe demonstrate poor accuracy and precision. A lower capacity syringe may improve accuracy, while a low dead space plunger may improve precision.

Cited by 18 publications

References 11 publications

A new method for pharmaceutical compounding and storage of anti-VEGF biologics for intravitreal use in silicone oil-free prefilled plastic syringes

A new method for pharmaceutical compounding and storage of anti-VEGF biologics for intravitreal use in silicone oil-free prefilled plastic syringes

<p>Issues with Intravitreal Administration of Anti-VEGF Drugs</p>

The influence of dead spaces and the designs of injectors on the amount of drug dose in intra-vitreal injection

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