Critical analysis of techniques and materials used in devices, syringes, and needles used for intravitreal injections

• Published in: Progress in retinal and eye research Vol. 80; p. 100862
• Main Authors: Melo, Gustavo Barreto, Cruz, Natasha Ferreira Santos da, Emerson, Geoffrey Guy, Rezende, Flávio Atanázio, Meyer, Carsten H., Uchiyama, Susumu, Carpenter, John, Shiroma, Hélio Francisco, Farah, Michel Eid, Maia, Maurício, Rodrigues, Eduardo Büchele
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-01-2021
• Subjects: Anesthesia; Device; Intravitreal injection; Needle; Silicone oil; Syringe; Syringe; Anesthesia; Intravitreal injection; Device; Needle; Silicone oil
• ISSN: 1350-9462; 1873-1635
• DOI: 10.1016/j.preteyeres.2020.100862

Intravitreal injections have become the most commonly performed intraocular treatments worldwide. Because intravitreal injections may induce severe adverse events, such as infectious and noninfectious endophthalmitis, cataract, ocular hypertension, vitreous hemorrhage, or retinal detachment, appropriate awareness of the materials and techniques used are essential to reduce these sight-threatening complications. This review provides insights into the needles, syringes, silicone oil coating, sterilization methods, devices to assist intravitreal injections, scleral piercing techniques using needles, syringe handling, anesthesia, and safety issues related to materials and techniques. It is paramount that physicians be aware of every step involved in intravitreal injections and consider the roles and implications of all materials and techniques used. The ability to understand the theoretical and practical circumstances may definitely lead to state-of-the-art treatments delivered to patients. The most important practical recommendations are: choosing syringes with as little silicone oil as possible, or, preferably, none; avoiding agitation of syringes; awareness that most biologics (e.g., antiangiogenic proteins) are susceptible to changes in molecular properties under some conditions, such as agitation and temperature variation; understanding that improper materials and techniques may lead to complications after intravitreal injections, e.g., inflammation; and recognizing that some devices may contribute to an enhanced, safer, and faster intravitreal injection technique.
•Syringes should have as little silicone oil as possible or none at all.•Drug in the vial or the syringe should never be agitated.•New devices might play a role in assisting the intravitreal injection.•Materials and techniques might cause complications when used inappropriately.•The choice of the anesthetic technique is important for better patient comfort.