Survey of intravitreal injection techniques and treatment protocols among retina specialists in Canada

doi:10.1016/j.jcjo.2014.03.009

Canadian Journal of Ophthalmology

Volume 49, Issue 3, June 2014, Pages 261-266

https://doi.org/10.1016/j.jcjo.2014.03.009 Get rights and content

Abstract

Objective

To describe intravitreal injection (IVI) techniques and treatment protocols by retina specialists in Canada from August 1, 2012, to October 1, 2012.

Design

Cross-sectional survey.

Participants

All fellowship-trained retina specialists across Canada, as identified from the Canadian Ophthalmological Society directory and the Canadian Retina and Vitreous Society directory.

Methods

An anonymous 28-question survey was sent to 125 retina specialists across Canada by email. Reminder letters were sent by email, mail, and fax as necessary.

Results

A total of 75 (63%) retina specialists responded to the survey. Most IVIs were performed in the office. Most surgeons did not use gloves (61%), sterile draping (91%), or surgical mask (71%). Antisepsis was used on conjunctiva by 100% and on periocular skin by 48%. Nearly all specialists used a sterile lid speculum (91%). Common anaesthetics included topical proparacaine or lidocaine drops (90%), topical lidocaine gel (25%), topical pledget (23%), and subconjunctival lidocaine injections (23%). Most (83%) dilate the pupil before IVI. Prophylactic topical antibiotics were used by 43%; 50% of these were started immediately after IVI. Injection location was estimated by visualization by 45%. A majority (63%) inject inferotemporally. Anterior chamber paracentesis was performed routinely by 5%. Optic nerve perfusion was formally assessed by 48%. The most common treatment protocol for age-related macular degeneration was treat and extend. For both diabetic and retinal vein occlusion–related macular edema, the most common protocol was 3 initial monthly injections with PRN follow-up.

Conclusions

A wide variety of IVI practice patterns exist in terms of aseptic technique, anaesthetics, prophylactic antibiotics, postinjection monitoring, and treatment protocol.

Résumé

Objet

Description des techniques d’injection intravitréenne (IIV) et des protocoles de traitement par les spécialises de la rétine du Canada, du 1er août 2012 au 1er octobre 2012.

Nature

Sondage transversal.

Participants

Tous les spécialistes formés à cet effet au Canada et identifiés par le directoire de la Société canadienne d’Ophtalmologie et celui de la Société canadienne de la rétine et du vitré.

Méthodes

Un sondage anonyme de 28 questions a été envoyé par courriel à 125 spécialistes de la rétine du Canada. Des lettres de rappel ont été envoyées par courriel, la poste et télécopie au besoin.

Résultats

En tout, 75 spécialistes de la rétine (63 %) ont répondu au sondage. Les IIV ont pour la plupart été administrées au bureau. La plupart des chirurgiens n’ont pas utilisé de gants (61 %), de drap stérile (91 %) ni de masque chirurgical (71 %). Tous ont utilisé l’antisepsie sur la conjonctive et 48 % sur les zones périoculaires. Presque tous ont utilisé un spéculum à paupière stérile (91 %). Les anesthésiques les plus utilisés comprenaient les goutes de proparacaïne ou de lidocaïne topique (90 %), le gel de lidocaïne topique (25 %), le pledget topique (23 %) et les injections sous-conjonctivales de lidocaïne (23 %). La plupart (83 %) dilatent la pupille avant l’IIV. 43 % ont utilisé les antibiotiques topiques prophylactiques; 50 % d’entre eux ont commencé immédiatement après l’IIV. 45 % ont estimé l’endroit de l’injection par visualisation. La majorité (63 %) injectent au site inférotemporal. 5 % ont effectué la paracentèse de la chambre antérieure de façon routinière. 48 % ont évalué formellement la perfusion du nerf optique. Le protocole de traitement le plus utilisé pour la dégénérescence maculaire liée à l’âge était celui de Traitement et Extension. Pour l’œdème maculaire associé au diabète et à l’occlusion de la veine rétinienne, le protocole le plus répandu était trois injections mensuelles initiales avec suivi PRN.

Conclusions

Il y a une grande variété de modes de pratique d’IIV concernant la technique antiseptique, l’anesthésie, les antibiotiques prophylactiques, le suivi post-injection et le protocole de traitement.

Section snippets

Methods

In August 2012, 120 practicing members of the Canadian Ophthalmological Society who self-categorized as having retina fellowship training and members of the Canada Retina and Vitreous Society were contacted with a confidential, 28-question survey through their listed contact method. Nonresponders were sent repeat emails, faxed surveys, and mailed a copy of the survey along with a prepaid return envelope. A minimum of 4 attempts was made to contact each nonresponder before the study concluded on

Results

There were 80 respondents, giving a response rate of 64%. The response rate was lower in Quebec with 9 of 20 (45%) responding. Five of the respondents indicated they were no longer practicing ophthalmology; they were therefore excluded from further analysis.

Demographics: Forty-four percent of respondents had both an academic and a community practice, 27% had academic only, and 30% had community only. The majority (55%) practiced both medical and surgical retina, whereas 45% practiced medical

Discussion

Several suggested practices guidelines for IVIs have been discussed in recent years.4, 5, 6, 7, 8, 9, 10 Similar to other recent surveys of IVI technique, we report a wide range of practice patterns in terms of aseptic technique, anaesthetics, antibiotics, postinjection monitoring, and treatment protocol by Canadian retina specialists.11, 12

Conclusion

Our study had an overall response rate of 64%. This compares favourably with recent national surveys of Canadian ophthalmologists regarding DME treatment protocols and cataract surgery practices, as well as the recent U.S. IVI techniques survey.12, 47, 48 A possible limitation, as in any survey, is selection bias in the surgeons who chose to respond.

We demonstrated there are various IVI practice patterns by retina specialists in Canada. Overall, Canadian surgeons’ practice patterns were similar

Disclosure

The authors have no proprietary or commercial interest in any materials discussed in this article.

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Original ArticleSurvey of intravitreal injection techniques and treatment protocols among retina specialists in Canada

Abstract

Objective

Design

Participants

Methods

Results

Conclusions

Résumé

Objet

Nature

Participants

Méthodes

Résultats

Conclusions

Section snippets

Methods

Results

Discussion

Conclusion

Disclosure

Mayo Clin Proc

J Fr Ophtalmol

J Fr Ophtalmol

Am J Ophthalmol

Am J Ophthalmol

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Am J Ophthalmol

Ophthalmology

Can J Ophthalmol

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Can J Ophthalmol

Can J Ophthalmol

Über die Behandlung der Netzhautablösung durch operative Entleerung der subretinalen Flüssigkeit und Einspritzen vom Luft in den Glaskörper

Graefe Arch Klin Ophthalmol

The International Intravitreal Bevacizumab Safety Survey: using the internet to assess drug safety worldwide

Br J Ophthalmol

Original Article
Survey of intravitreal injection techniques and treatment protocols among retina specialists in Canada