|Articles|June 15, 2015

Best practices for injection protocols

No doubt, my retina colleagues are way ahead of me in considering this issue. Reducing the frequency of injections by developing longer-lasting therapeutic agents and reducing the per-injection risk by careful scrutiny of evidence to determine the best practice when it comes to injection protocols are two possibilities.

 

 

By Peter J. McDonnell, MD

A year or so ago, my friend’s brother lost vision from choroidal neovascularization due to age-related macular degeneration (AMD). He received an intravitreal injection of an anti-vascular endothelial growth factor (VEGF) agent by a well-regarded retinal specialist in the Midwest. Within 48 hours, he had severe endophthalmitis and ultimately, lost all vision in the eye.

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I thought of my friend’s brother while reading an article recently on the topic of post-injection endophthalmitis in patients with age-related macular degeneration (AMD)-Yes, it is possible for refractive surgeons to read and even comprehend literature on retinal diseases, provided the authors avoid using big words. In the study, use of pre- and post-injection antibiotics was left to the discretion of the treating ophthalmologist, and the article concludes that the use or nonuse of antibiotics did not appear to influence the risk of infection.

What caught my eye was the overall risk of infection and the authors’ take on that risk. Endophthalmitis developed after 11 of 18,509 injections (1 per 1,700; 0.06%) and in 11 of 1,185 patients (0.93%).

“Wow!” I thought. “One percent of patients get endophthalmitis when treated with anti-VEGF therapy for AMD. That’s a big problem.”

Depends on definition of ‘low’

The paper offered a distinctly different interpretation, starting off the conclusions section with “Rates of endophthalmitis were low . . . .”

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