![]() ![]() However, performing IVI in the operating room (OR), a more controlled and sterile environment, may decrease EO incidence… but at considerable cost.ĮO rates after IVI performed in the OR are very low. In fact, many papers on IVI do not mention the setting, as in-office IVI is assumed. IVIs are generally performed in the office. "Areas for improvement" that remain are much of what this article will discuss. Noncompliance with standards and poor aseptic technique were the most likely cause, and implementation of and strict adherence to United States Pharmacopoeia requirements has since been emphasized. EO rates reported in large multi-center randomized controlled trials of anti-vascular endothelial growth factor (anti-VEGF) IVI range from 0.019% to 0.09% per injection.Ĭlose examination of the events surrounding historical large outbreaks of infectious EO suggest that these outbreaks were not a result of the drug or the injection technique, but rather of the pharmacological compounding procedures used to prepare the syringes containing the drug. The most dreaded complication of IVI, though rare, is endophthalmitis (EO), and much of IVI protocol is designed to minimize, or eliminate, EO due to human error. Patients may also develop floaters, vitreous or retinal hemorrhage, and retinal detachment. ![]() IVI Complications: Why we debate protocol in the first place…Ĭommon complications of IVI are injection site discomfort, subconjunctival (SC) hemorrhage, vitreous reflux, and transient elevation of intraocular pressure (IOP). We aim to present a helpful, concise review of recent evidence surrounding IVI technique and describe IVI protocols at the Iowa City Veterans Affairs hospital and the University of Iowa. This article is intended to be a resource and primer for ophthalmology residents learning IVI. Unfortunately, a wide variety of IVI protocols exist in terms of aseptic technique, anesthetics, use of prophylactic antibiotics, and post-injection monitoring. While this "scope of practice" debate continues on, ophthalmology residency programs are now training their residents to properly perform IVIs as part of a comprehensive curriculum. Given the risk of complications, especially endophthalmitis and suprachoroidal hemorrhage, and the need to handle these complications, IVI by generalists is controversial and even opposed by some vitreoretinal specialists. This procedure, considered a subspecialty skill, is increasingly performed in the office of comprehensive ophthalmologists, especially for the treatment of common eye diseases like choroidal neovascularization in age-related macular degeneration. It is estimated that over four million IVIs were performed in the United States in 2013, a number that is expected to continue to increase. Treatment of retinal disease by intravitreal injection (IVI) has revolutionized the field of ophthalmology. Lorraine Myers (Provencher), MD, David Almeida, MD, PhD, Michael D. They told us, we're going to open the incubator so you can say your last words to him and say goodbye," Cardenas explained.Intravitreal Injection Technique A Primer for Ophthalmology Residents and Fellows The new mom and dad were told to prepare for the worst, even calling in a priest to baptize their newborn son. He had seizures and his oxygen levels kept dropping. He was lacked nutrients in the womb and forced Ivanna Gutierrez to give birth three months earlier. Gabriel, "Baby D," was one of four naturally conceived quadruplets. The parents said they didn't hesitate, choosing to deliver all four babies that very same day, even though they were only given a 40 percent chance of survival.Īll four babies went straight to the neonatal intensive care unit, or NICU, but little Gabriel was in the fight for his life. ![]() "You need to make the decision right now if you want to keep going with the pregnancy and one of the babies will die in your belly or go ahead and take them out." "One of the babies is not receiving enough oxygen through the placenta," she recalled the doctor telling her. They knew the pregnancy would be high risk, but that reality came into sharp focus when at just 27 weeks pregnant, during an appointment at Jackson Memorial Hospital in Miami, the doctor gave Cardenas some devastating news. ![]()
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