Intravitreal Injections in Arc Sterile Setting: Safety Profile after More Than 10,000 Treatments.

Claudio Furino,Vito Bini,Annalisa Nacucchi,Michele Reibaldi,Giovanni Alessio,Maria Oliva Grassi,Francesco Boscia,Nicola Recchimurzo

doi:10.1155/2020/3680406

Abstract

Purpose To report the occurrence of endophthalmitis and other complications after intravitreal injections (IVIs) in the Arc Sterile setting. Methods A retrospective study that enrolled all patients who underwent IVIs between November 2017 and March 2019, collecting data about the patient's gender and age, type of injected drug, diagnosis, other ocular pathologies, physician and possible occurrence of endophthalmitis, or other complications. Results Ten thousand and eighty-three IVIs were performed during the study period, involving 2014 eyes of 1,670 patients with an average age of 71.37 ± 11.63 years. The injected drugs included ranibizumab (54.6%), aflibercept (38.0%), dexamethasone (6.7%), pegaptanib (0.3%), bevacizumab (0.4%), and ocriplasmin (0.01%). The diagnosis included neovascular age-related macular degeneration (859), myopic choroidal neovascularization (154), diabetic macular edema (576), retinal vein occlusion (203), and miscellaneus diagnosis (222). No cases of endophthalmitis were recorded. One hundred and sixty-nine cases of ocular hypertension were detected, while the most frequent complication was subconjunctival hemorrhage, identified after 1,180 IVIs. The residents performed over 80% of IVIs, but there was no statistically significant difference in incidence of complications between the residents group and consultants group. Conclusions Arc Sterile seems to be a safe setting in which IVIs can be carried out, regarding infective risk, and it is easy to set up compared to operation theatre and useful to improve intravitreal injections governance.

Highlights

Intravitreal injection (IVI) is the most common performed ophthalmic procedure. It is currently used in the treatment of neovascular age-related macular degeneration, myopic neovascularization, and in macular edema due to retinal vein occlusion, diabetes, or other pathologies [1]
Arc Sterile is an ISO 5 class device; it means that it guarantees the limit of 3,520 uncontrolled particles in one m3 of air reducing the number of microorganisms in it and preventing the sedimentation of microorganisms inside the wounds. is is possible because the laminar flow sweeps over the surgical area with clean air without turbulence
E aim of the study was to evaluate complications of IVIs performed in Arc Sterile setting in a context of a high volume tertiary Italian center

Summary

Introduction

Intravitreal injection (IVI) is the most common performed ophthalmic procedure. E aim of the study was to evaluate complications of IVIs performed in Arc Sterile setting in a context of a high volume tertiary Italian center. Postoperative adverse events and complications associated with IVIs were evaluated, like endophthalmitis, intraocular inflammation, rhegmatogenous retinal detachment, intraocular pressure (IOP) elevation (we considered an IOP cut-off level of 23 mm Hg for ocular hypertension diagnosis), and ocular haemorrhage.

Results

Conclusion