Practice Patterns and Safety Protocols in Anti-VEGF Intravitreal Injections: Insights from Portugal

Abstract

INTRODUCTION: Intravitreal injections (IVIs) of anti-vascular endothelial growth factor (VEGF) agents have revolutionized the treatment of retinal diseases, becoming a routine procedure for ophthalmologists worldwide. Despite their widespread adoption, the approaches to IVIs, encompassing preparation, technique, and antibiotic usage, exhibit significant diversity among healthcare providers. This study aims to investigate the current practice patterns and safety protocols of anti-VEGF IVIs in Portugal.

METHODS: Cross-sectional survey of Portuguese ophthalmologists who administer intravitreal anti-VEGF injections. Participants completed an online and anonymous 29-question survey.

RESULTS: A total of 144 Portuguese ophthalmologists across the country participated, with an average of 11.3±1.1 years in practice (27.1% retinal specialists). IVIs settings exhibited variability, with 77.8% conducted in operating rooms (OR) and 22.2% in procedure rooms outside the OR. Only 2.1% of the participants prescribed topical antibiotics before injection. Furthermore, 55.6% consistently replaced surgical gowns between procedures, 97.2% typically employed a lid speculum and 59.0% never used microscope. Povidone-iodine (PI) scrub at a concentration of 10% was performed on the periocular region by 97.9% of practitioners, and all applied a 5% PI solution to the ocular surface at some point prior to the intravitreal injection (IVI). A surgical time-out before the procedure was conducted by 44.4%. Most respondents (61.8%) were injected in the supero-temporal quadrant for both eyes. Regarding bilateral injections, 41.7% would typically perform them on the same day, whereas 30.6% would never consider it. After injection, 39.6% applied topical antibiotics, 20.8% lubricants or saline solution, and 6.2% topical intraocular pressure (IOP)-lowering medication. Longer-standing physician in practice was associated with the use of antibiotics (p = 0.008) and IOP-lowering medication (p = 0.020) after IVI. A total of 45.1% did not regularly assess optic nerve perfusion and 11.8% routinely prescribed topical antibiotics for home use after every IVI.

CONCLUSION: This survey underscores the heterogeneity in the Portuguese ophthalmologists' practices during IVI. Most physicians have aligned with the current trend of not using perioperative antibiotics, reflecting updated recommendations in the field. The practice of eyelid scrub and the consistent use of a lid speculum, although controversial in the literature, remain largely consensual among the Portuguese ophthalmologists.