Intravitreal Injection Procedure Explained

Jan 11, 2025

Intravitreal Injections Procedure by Dr. James Folk

Introduction

  • Intravitreal injections are commonly used for treating retinal diseases.
  • Procedures are demonstrated from the University of Iowa.

Injection Technique

  • Injection Site:
    • Pseudophagic eyes: 3mm posterior to the limbus
    • Phagic eyes: 3.5mm posterior to the limbus
  • Needle Sizes:
    • 27 gauge for catalog and macugen
    • 30 gauge for Avastin and intravitreal antibiotics

Equipment

  • Mayo stand setup includes:
    • Toothed forceps
    • Lid speculum
    • 5% betadine
    • Drape
    • Caliper

Procedure Steps

  1. Preparation:

    • Apply regular topical eye drops.
    • Add 4% lidocaine at injection site (inferior temporally).
    • Use two forceps to elevate conjunctiva and inject subconjunctival xylocaine.
    • Elevate a large bleb of xylocaine for pain-free injection.

  2. Sterilization:

    • Nurse paints eyelids and eyelashes with betadine.
    • Apply drape over the eye and insert lid speculum.
    • Paint injection site with 5% betadine (important for infection prevention).

  3. Injection:

    • Measure site with calipers.
    • Stabilize eye with a Q-tip.
    • Inject intravitrally.
    • Wait 2-3 minutes after subconjunctival xylocaine before proceeding for a pain-free injection.
    • Post-injection: Place Q-tip at the site to check for leaks and remove the needle.

  4. Post-Injection Care:

    • Ensure the patient can see hand movements post-injection.
    • Administer topical antibiotic (e.g., Quixin).
    • Inform about potential dark spots or floaters from the injection.

Precautions

  • Antibiotics may not significantly reduce endophthalmitis risk; used mainly for legal reasons.
  • Release protocols vary among colleagues:
    • Immediate release if patient sees light.
    • Some wait until intraocular pressure is ≤ 35 mmHg.

Patient Instructions

  • Warn about possible discomfort and decreased vision.
  • Advise calling immediately if symptoms become severe.

Conclusion

  • Final advice for successful intravitreal injections.
  • Dr. James C. Folk extends good luck to practitioners.