Hi, this is Dr. James Folk. We thought we'd show you a video of how we do intravitreal injections at the University of Iowa because intravitreal injections are used so commonly for the treatment of retinal diseases. We normally inject three millimeters posterior to the limbus in pseudophagic eyes and three and a half millimeters posteriorly in phagic eyes. We typically use 27 gauge needles for a catalog.
and macugen and 30 gauge needles for Avastin and intravitreal antibiotics. You can see here our Mayo stand that shows toothed forceps, lid speculum, 5 percent betadine, and also a drape and caliper. First we just put regular topical eye drops in the eye and then add some 4 percent lidocaine inferior temporally at our ejection site. I like to use two forceps to elevate the conjunctiva and then inject subconjunctival xylocaine. I like to raise a large bleb of xylocaine so it can absorb and give a pain-free injection.
The nurse then will paint the eyelids and the eyelashes with the betadine preparation. I'm not sure that this is necessary, but this is how it's been described as standard of care. I then put the drape over the eye and the lid speculum into the eye.
What I do think is important is to paint the site of injection with 5% betadine because that's where any infection will be introduced. I measure with my calipers. I then stabilize the eye with a Q-tip and inject intravitrally.
Wait at least two or three minutes after the subconjunctival injection of xylocaine in order for the injection to pain-free. Once the injection is complete, I put the Q-tip at the injection site to make sure there's no leak and remove the needle. Afterwards, I make sure the patient can at least see my hands. If she can see my hands, I don't worry too much about the intraocular pressure. A post-injection, I warn patients that they may see a dark spot from an air bubble that can go in with the medicine or certainly floaters from the canalog injection.
We give them a topical antibiotic. Typically, we give Quixin, but any antibiotic would probably be worthwhile. Frankly, the antibiotic will probably not reduce the risk of endophthalmitis and is done mainly for legal purposes. I told you that if the patient can see light, I let them go home immediately. Some of my colleagues, however, will not release them until their intraocular pressure is 35 millimeters or below.
Finally, you also have to warn the patient. That they may have a little bit of discomfort and a little bit of decreased vision, but if either of those become severe, they should call immediately. This is James C. Folk at the University of Iowa, and good luck with your intravitreal injection.