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      Survey of Intravitreal Injection Techniques Among Retina Specialists in Mexico

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          Abstract

          Purpose

          To report technique preferences for intravitreal injections among retina specialists in Mexico.

          Methods

          Cross-sectional survey. Ophthalmologists with a two-year retina training, active members of the Mexican Retina Association, were contacted through email to answer a survey consisting of 37 items regarding their IVI application technique.

          Results

          A total of 133 retina specialists participated, with a response rate of 78%. Forty-five percent applied the intravitreal injections in an operating room designated for the procedure. Sixty-three percent reported never injecting both eyes on the same day. Ninety-six percent wore a face mask during the procedure and 91% wore gloves. Eighty-two percent used a lid speculum. Tetracaine drops were the anesthetic method employed by 97% of participants. All participants utilized povidone-iodine for antisepsis. Eighty percent measured the puncture site with a caliper. Superotemporal quadrant was the one chosen to place the injection by 63% of participants. Fifty-nine percent indicated post-injection antibiotic drops for several days. Post-injection counting fingers visual acuity was verified by 53% of the participants. Fifty-six percent of the participants placed an eye-patch after the procedure.

          Conclusion

          There are different practices regarding the application of intravitreal injections among retina specialists in Mexico. Performing this type of survey periodically could show changes in preferences, as new evidence is incorporated into clinical practice.

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          Most cited references54

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          Adverse events and complications associated with intravitreal injection of anti-VEGF agents: a review of literature.

          Intravitreal injection of anti-vascular endothelial growth factor (VEGF) agents is increasingly used for the treatment of a wide variety of retinal diseases, including age-related macular degeneration, diabetic retinopathy and retinal vascular occlusions, and retinopathy of prematurity. Despite encouraging results in halting the disease and improving the vision, intravitreal injection of anti-VEGF agents may be associated with systemic adverse events and devastating ocular complications. In this review, we provide an overview of safety data for intravitreal injection of common anti-VEGF agents.
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            Meta-analysis of endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor agents: causative organisms and possible prevention strategies.

            To report the rates of endophthalmitis and the spectrum of causative organisms after intravitreal injection of anti-vascular endothelial growth factor agents and possible prevention strategies. Meta-analysis of the U.S. literature from 2005 to 2009 reporting endophthalmitis bacterial isolates after intravitreal injection of anti-vascular endothelial growth factor agents and comparison with reports of endophthalmitis bacterial isolates after intraocular surgery in the United States. Endophthalmitis after intravitreal injection occurred in 52 of 105,536 injections (0.049%) (95% confidence interval [CI], 0.038-0.065%). Among 50 cases of endophthalmitis with bacterial culture isolates, 24 (48.0% [95% CI, 34.8-61.5%]) were culture negative and 26 (52% [95% CI, 38.5-65.2%]) were culture positive. Among the 26 culture-positive isolates, causative organisms were coagulase-negative Staphylococcus in 17 cases (65.4% [95% CI, 46.0-80.6%]), Streptococcus species in 8 cases (30.8% [95% CI, 16.5-50.2%]), and Bacillus cereus in 1 case (3.8% [95% CI, 0.9-19.0%]). Streptococcus species were significantly more frequent after intravitreal injection than after intraocular surgery in the Endophthalmitis Vitrectomy Study (29 of 226 isolates, 9.0% [95% CI, 6.3-12.6%], P = 0.005), a report on clear corneal cataract surgery endophthalmitis (6 of 73 isolates, 8.2% [95% CI, 3.9-16.8%], P = 0.022), and a report on postvitrectomy endophthalmitis with no cases of Streptococcus species. Streptococcal isolates are approximately three times more frequent after intravitreal anti-vascular endothelial growth factor injection than after intraocular surgery. Strategies to consider minimizing oropharyngeal droplet transmission may include avoiding talking, coughing, and sneezing or wearing surgical masks.
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              2018 Update on Intravitreal Injections: Euretina Expert Consensus Recommendations

              Intravitreal injections (IVI) have become the most common intraocular procedure worldwide with increasing numbers every year. The article presents the most up-to-date review on IVI epidemiology and techniques. Unfortunately, important issues related to pre-, peri- and postinjection management lack randomized clinical trials for a final conclusion. Also, a great diversity of approaches exists worldwide. Therefore, expert consensus recommendations on IVI techniques are provided.
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                Author and article information

                Journal
                Clin Ophthalmol
                Clin Ophthalmol
                opth
                clinop
                Clinical Ophthalmology (Auckland, N.Z.)
                Dove
                1177-5467
                1177-5483
                26 November 2020
                2020
                : 14
                : 4089-4098
                Affiliations
                [1 ]Hospital San Angel Inn Universidad , Mexico City, Mexico
                [2 ]Retina Department, Hospital Regional “Lic. Adolfo Lopez Mateos” ISSSTE , Mexico City, Mexico
                [3 ]Hospital Angeles Lomas , Mexico City, Mexico
                [4 ]Retina Department, Asociacion Para Evitar La Ceguera En Mexico , Mexico City, Mexico
                [5 ]Centro Oftalmologico Arcos , Queretaro, Mexico
                [6 ]Retina Department, Instituto Nacional De Rehabilitacion , Mexico City, Mexico
                [7 ]School of Medicine and Health Sciences, Tecnologico De Monterrey , Mexico City, Mexico
                Author notes
                Correspondence: Andree Henaine-Berra Hospital San Angel Inn Universidad , Av. Rio Churubusco #601 Suite 928, Xoco, Benito Juarez, Mexico City03330, MexicoTel +52 55 6818-0116 Email andreehenaine@gmail.com
                Author information
                http://orcid.org/0000-0002-9705-3832
                http://orcid.org/0000-0003-4515-2449
                http://orcid.org/0000-0001-6056-9475
                Article
                285955
                10.2147/OPTH.S285955
                7705264
                33273805
                dfec20c2-0883-497d-b78d-300cdc385595
                © 2020 Henaine-Berra et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                : 09 October 2020
                : 04 November 2020
                Page count
                Figures: 0, Tables: 2, References: 56, Pages: 10
                Funding
                Funded by: the Mexican Retina Association;
                This study is partially funded by the Mexican Retina Association.
                Categories
                Original Research

                Ophthalmology & Optometry
                intravitreal injections,retinal diseases,anti-vegf agents,topical antibiotics

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