Intravitreal injections come with many options
Key takeaways:
- There are more options available than just the standard methods.
- Choices need to be made for every step of the injection procedure.
KOLOA, Hawaii — Retina specialists have a lot of options when it comes to intravitreal injection procedures, according to a speaker at Retina 2025.
Michael Singer, MD, said that every part of the injection process has alternatives to the gold standard.
“There is such a spectrum of how people do all the little things,” he said. “What are all your options out there? We all take it for granted and are stuck in our ways, but there are a lot of things you may not have thought of, and as a result, there may be more options available.”
For the prep stage, the gold standard is povidone-iodine, Singer said, but options such as chlorhexidine and hypochlorous acid are also available for infection prophylaxis.
Anesthesia options include topical, local and gel. While the common thinking has been that gels increase the risk for endophthalmitis, Singer said a recent study found that one kind of gel, chloroprocaine, was noninferior to tetracaine and had a higher mean percent reduction in colony forming units.
For the actual injection, Singer said there are a lot of ways to change up syringes or applicators. For more viscous medications, Singer said a syringe using a Luer lock prevents the needle from popping out.
Location of the injection can also make a difference. Singer said an injection at the superior temporal quadrant is safer than at the inferotemporal quadrant with less chance for endophthalmitis.
While the vast majority of physicians do a washout of the povidone-iodine after an injection, Singer said recent research shows that this may lead to more bacterial growth after treatment.
“Even though retina specialists perform many intravitreal injections, there is a wide range of choices in how you do it and what’s involved,” he said. “It’s not as simple as it looks.”
References:
- Hejkal TW, et al. J Vitreoretin Dis. 2021;doi:10.1177/24741264211013622.
- Ilyas H, et al. Clin Ophthalmol. 2024;doi:10.2147/OPTH.S454496.
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Singer M. Optimizing intravitreal injections. Presented at: Retina 2025; Jan. 18-24, 2025; Koloa, Hawaii.
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