Evolving Guidelines for Intravitreous Injections

Abstract

Intravitreous (i.v.t.) injection is increasingly being incorporated into the management of ocular diseases. While only fomivirsen sodium (Vitravene) is currently approved by the Food and Drug Administration as an i.v.t. injection, the number of approved i.v.t. injections indications is anticipated to grow on the basis of promising results from ongoing clinical studies. Despite the potential benefits that may be derived from intraocular injections of different agents, no guidelines have been published previously for i.v.t. injection. The purpose of this document is to identify specific strategies for the delivery of i.v.t. injection that may reduce risks and improve outcomes. Consensus was sought among a panel of investigators, surgeons experienced with this technique, and industry representatives. Objective evidence was sought for all guidelines, but consensus was accepted where evidence remains incomplete. In the absence of either evidence or consensus, the current manuscript identifies outstanding issues in need of further investigation. It is anticipated that more complete guidelines will evolve over time, potentially altering some of the guidelines included here, based on new applications of i.v.t. injection, additional clinical experience, and results of clinical trials.

Practice patterns of ophthalmologists administering intravitreal injections in Europe: a longitudinal survey

“…The findings of this study showed that a majority of treating ophthalmologists reported use of gloves, draping, pre-injection topical antibiotics, povidone–iodine, eyelid speculum, and post-injection topical antibiotics when performing IVT injections as recommended by the guidelines 3. Thus, it was concluded that treating ophthalmologists had a good adherence to all aspects of the guidelines on IVT injections.…”

“…It is important to note that educational materials and two published articles on treatment guidelines of IVT injections2,3 were distributed at the investigator meetings prior to patient enrollment. Although the authors would like to draw a direct conclusion between the introduction of educational materials and the adherence to the guidelines, as noted, the questionnaires only assess knowledge rather than actual behavior; the authors consider the introduction of educational materials may provide reinforcement of knowledge.…”

“…The education materials consisted of two guidance articles2,3 and an explanatory CD-ROM slide presentation of the proper technique for IVT injections. One of the two articles was a review article on minimizing the risk of endophthalmitis following IVT injection2 and the other was guidelines on IVT injections 3. The guidelines were based on round-table deliberations conducted after a review of published and unpublished studies and case series on IVT injections.…”

Hsp27 knockdown using nucleotide-based therapies inhibit tumor growth and enhance chemotherapy in human bladder cancer cells

“…Although no studies have yet been reported that assess pharmacokinetic and pharmacodynamic activity of ASO after intravesical delivery in humans, preclinical studies would suggest that ASO are taken up by urothelium (47,48). Interestingly, the only approved clinical indication for an ASO is for intravitreal injection of cytomegalovirus-induced retinitis in human immunodeficiency virus, illustrating the potential clinical utility of local instillation for this class of therapeutics (49).…”

Immediate intraocular pressure changes following intravitreal injections of triamcinolone, pegaptanib, and bevacizumab

“…The current recommendation for performing intravitreal injections advises against performing a paracentesis. 1 However, in patients who suffer from glaucoma or optic nerve damage, there is a concern that a transient high IOP elevation may further damage the ganglion cells in the optic nerve. It is important to know the transient IOP elevations that patients are subjected to after such intravitreal injections for several reasons, such as to assess whether a paracentesis is necessary, whether IOP monitoring is necessary after the procedure, and to reassess, when manufacturing a new drug, the optimum amount of fluid to be injected into the eye.…”