Survey of Intravitreal Injection Techniques Among Retinal Specialists in the United States

PURPOSE: To describe the intravitreal injection technique practice patterns of retinal specialists in the United States from April 8, 2010 to April 21, 2010. DESIGN: Questionnaire survey. METHODS: All members of the American Academy of Ophthalmology who self-categorized as Retinal/Vitreous Surgery were contacted by e-mail to complete an anonymous, 20-question, internet-based survey. RESULTS: A total of 765 retinal specialists (44%) responded to the survey. Most respondents wear gloves (58%) and use an eyelid speculum (92%) when performing an intravitreal injection. More than 99% use povidone-iodine preinjection. The majority measure the injection site from the limbus (56%) and inject straight into the vitreous cavity (96%). Most do not displace the conjunctiva (83%). Seventy-two percent routinely assess postinjection optic nerve perfusion, primarily by gross visual acuity measurement (32%). While nearly one third of participants use prophylactic topical antibiotics preinjection, more than two thirds use topical antibiotics postinjection. Forty-six percent perform bilateral simultaneous intravitreal injections. The majority of respondents use a 30-gauge needle for the injection of ranibizumab (78%) and bevacizumab (60%). However,, respondents use both a 27- and 30-gauge needle for the injection of triamcinolone acetonide. CONCLUSIONS: Retinal specialists in the United States participate in a range of techniques for the care before, during, and after intravitreal injections. Further study is needed to elucidate best practice patterns. (Am J Ophthalmol 2011;151:329-332. (C) 2011 by Elsevier Inc. All rights reserved.)