Same-day bilateral intravitreal anti-vascular endothelial growth factor injections: Experience of a large Canadian retina centre

Session Details

Session Title: Free Paper Session 22: AMD V

Session Date/Time: Sunday 10/09/2017 | 08:00-09:30

Paper Time: 08:42

Venue: Room 115

First Author: : C.Francisconi CANADA

Co Author(s): :    D. Chow   R. Muni   L. Giavedoni   A. Berger   F. Altomare   D. Wong              

Abstract Details

Purpose:

Intravitreal injections are one of the most commonly performed ophthalmic procedures and bilateral anti-VEGF injections are frequently necessary in clinical practice, since many retinal diseases requiring this treatment occur bilaterally. The purpose of this study was to evaluate the outcomes and complications of bilateral same-day intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections.

Setting:

This was a single-centre study performed at the Department of Ophthalmology of St. Michael’s Hospital, Toronto, Canada.

Methods:

This is a retrospective consecutive series that included 444 eyes of 222 patients who received concomitant bilateral intravitreal anti-VEGF injections in the office by 6 different retinal specialists between September 2010 and January 2017. Patients with missing chart data were excluded. Medical records were reviewed for diagnosis, type of anti-VEGF agent, pre and post injection visual acuity (VA) and intraocular pressure (IOP), post injection complications, newly developed systemic conditions throughout follow-up or any patient’s intolerance of simultaneous bilateral injections. Everyone received bevacizumab, ranibizumab or aflibercept with similar intravitreal injection technique and had a separate povidone-iodine preparation, speculum, needle and syringe for each eye.

Results:

A total of 3643 injections were performed on bilateral eyes. Most patients (67.1%) had neovascular Age-related macular degeneration. Ranibizumab was the initiating anti-VEGF agent in 83.1% of the cases, aflibercept in 14.2% and bevacizumab in 2.7%. The mean logMAR VA pre bilateral injection and at final follow-up were minimally changed (0.67+0.53 and 0.66+ 0.55, respectively, p=0.423). The mean pre and post treatment IOP also remained stable (15.46+2.99 and 15.28+3.47, respectively, p=0.362). 29.4% of the eyes required a total of 418 anterior chamber paracentesis (mean per eye= 6.47+5.35, range 1-27) at the moment of injection due to an acute IOP rise. 30 eyes (6.8%) had a previous diagnosis of glaucoma and 18 (60.0%) of them presented at least 1 episode of acute IOP rise requiring an anterior chamber paracentesis after injection (p=0.007). The incidence of acute intraocular inflammation was 0.027%. 6 patients required extra visits due to new complaints after injection, such as blurred vision, floaters and redness, but none had clinically relevant findings on exam. 3 patients requested to change their treatment to alternating unilateral injections. None of the patients had vascular systemic complications, but 5 (2.3%) had nonvascular events. 2 (0.9%) patients died throughout follow-up due to nonvascular problems.

Conclusions:

This large retrospective study reinforces that same-day bilateral intravitreal anti-VEGF injections present low ocular and non-ocular complication rates and are well tolerated by patients. This practice reduces the burden on the health care system and on the patients. Appropriate safety precautions should be equally taken for both eyes and the patients should be well aware of the risks of injections. Further prospective studies comparing the impact of bilateral and unilateral anti-VEGF injections on systemic VEGF are necessary to confirm the safety of same-day bilateral injection approach.

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