INTRAVITREAL

INJECTION
INTRODUCTION

Intravitreal injection (IV) is the Most

Commonly Performed Ophthalmic Procedur.
It maximizes therapeutic drug delivery and
minimizes systemic complications, injecting
therapeutic agents (drugs/air/gases) inside
the vitreous cavity through pars plana under
aseptic precautions.
 INTRAVITREAL DRUGS
Anti VEGFs Steroid implants
a. Pegaptanib sodium a.Dexamethasone
b. Bevacizumab b. Fluocinolone
c. Ranibizumab
d. Aflibircept

Intravitreal steroids Antibiotics

Triamcinolone acetate a. Vancomycin
b. Cefazoline
c. Ceftazidine
d. Amikacin
INTRAVITREAL DRUGS

ANTIVIRALS AIR AND EXPANSILE GASES

a. Canciclovir a. Sulfur hexafluoride(SF6)
b. Foscarnet b. Perfluoropropane (C3F8)
c. Cidofovir c. Hexafluoroethane(C2F6)

ANTIFUNGALS ANTI METABOLITES

a. Amphotericine B a. Melphalan
b. Fluconazole b. Topotecan
c. Voriconazole c. Methotrexate
OTHER INDICATIONS

 ANTIBIOTICS AND ANTI FUNGALS

Endophthalmitis
 Anti Virals - Viral Retinitis In
Immunocompromised Patients
 Anti Metabolites- Chemotherapy
 Steroids- Macular Edema, Uveitis
NEEDLE SELECTION
NEEDLE SELECTION

Needle size varies according to the substance injected:

 27 and 30-gauge Needle length between 1/2 - 5/8 inches (12.7 to 15.75 mm)
is recommended
 Separate needles should be used to remove the medication from the vial and
to perform the actual injection, prevent contamination
 Studies suggest that smaller, sharper needles good for penetration and result
in less drug reflux.
 Longer needles increase risk of retinal injury if the patient accidentally moves
during procedure
TOPICAL IRRIGATION/ ANTISEPSIS

POVIDONE IODINE
Due to its broad spectrum
antimicrobial activity, low
incidence of microorganism
resistance, cost ,effectiveness,
and wide availability the
technique, concentration, and
TOPICAL IRRIGATION / ANTISEPSIS
contact time of povidone-lodine
still remains a matter of study.
CHLORHEXIDINE
Chlorhexidine o.1% alternative to
povidone-jodine for antisepsis,
efficacy of chlorhexidine similar to
povidone-jodine when
investigating ocular bacterial count
after antisepsis.
SALINE / BALANCED SALT
SOLUTION
in an attempt to decrease patient
discomfort & to minimize epithelial
toxicity, practitioners do irrigate ocular
surfaces after MI regardless of whether
chlorhexidine or povidone-lodine is
used as the antiseptic agent.
The most widely
preferred antiseptic
is 5% povidone-
iodine with contact
time of at least 30
secs.
ANESTHESIA

The primary goals of anesthesia are :

1) prevent patient movement and involuntary lid closure during
needle insertion
2) increase patient comfort and patient compliance for a
procedure that needs to be repeated frequently.
 Topical anesthesia and SC anesthesia are no different, but SC
anesthesia may have more side effects like SC hemorrhage
WHERE SHOULD IVI BE INJECT?

 Any clock hour of the eye can be used

 There is no clear agreement on the exact location. Injection in the
inferotemporal quadrant is common
 injections safely performed 360 through the pars plana, between 3.5
and 4 mm from the limbus
 A more posterior injection site potentially increases the risk of retinal
detachment, while a more anterior approach increases t risk of
traumatic cataract formation or hemorrhage, if the ciliary body is
pierced
The larger the injected volume, the greater the potential for an IOP spike.
Additionally, rapid injection may also contribute to transient IP elevation more
than a slower injection into the eyesure Spike Studies showed that a combination
of brimonidine 0.2% and timolol 0.5%, topical dorzolamide-timolol, performing
ocular decompression with a mercury bag, or applying digital eye globe massage
before the procedure significantly reduces OP after IVI

COMPLICATION