Expert discusses practical aspects of intravitreal injections

PARIS — Intravitreal injections have become a routine practice in ophthalmology, with more than 10,000 injections performed per month, according to a speaker at the meeting of the French Society of Ophthalmology.

The procedure has been simplified and is now mostly performed in an ambulatory setting under topical anesthesia. The protocols for disinfection and sterilization are now standardized, but there is still controversy on the use of preoperative topical antibiotics, on pupil dilation, on same-day bilateral injection and on postoperative surveillance.

Salomon Yves Cohen, MD, said the use of preoperative topical antibiotics is "not strictly necessary, and many surgeons don't use them." Three days of postoperative topical administration of antibiotic drops is sufficient to prevent complications. However, patients should be made aware of the typical signs of infection and report them immediately. Pupil dilation is not required in Dr. Cohen's opinion, and most experts are now reaching the same conclusion.

Bilateral injection, he said "is not advisable, but possible, provided that two separate sets of instruments and materials are used, as if it dealing with two separate procedures."

Studies have shown that the schedule of re-treatment can be flexible, but monthly visits are mandatory to decide if and when it is time to inject the patient again.