TY - JOUR
T1 - The ideal intravitreal injection setting
T2 - office, ambulatory surgery room or operating theatre? A narrative review and international survey
AU - Società Italiana della Retina (SIR) Study Group
AU - Intravitreal Injection Setting Study Group (I2SG)
AU - Veritti, Daniele
AU - Sarao, Valentina
AU - Chhablani, Jay
AU - Loewenstein, Anat
AU - Lanzetta, Paolo
AU - Bandello, Francesco
AU - Midena, Edoardo
AU - Nicolò, Massimo
AU - Parravano, Mariacristina
AU - Pilotto, Elisabetta
AU - Ricci, Federico
AU - Staurenghi, Giovanni
AU - Virgili, Gianni
AU - Arnold, Jennifer J.
AU - Augustin, Albert J.
AU - Creuzot-Garcher, Catherine
AU - Adrian, Monica Lövestam
AU - Mekjavić, Polona Jaki
AU - Patel, Praveen J.
AU - Rodriguez, Francisco J.
AU - Schumann, Ricarda
AU - Sharma, Ashish
AU - Silva, Rufino
AU - Zarranz-Ventura, Javier
N1 - Publisher Copyright:
© 2023, The Author(s).
PY - 2023/11
Y1 - 2023/11
N2 - Purpose: This study reviews evidence and provides recommendations for the ideal setting of intravitreal injection (IVI) administration of vascular endothelial growth factor (VEGF) inhibitors. Methods: A multi-step approach was employed, including content analysis of regulations and guidelines, a systematic literature review, and an international survey assessing perioperative complications and endophthalmitis incidence in relation to injection settings. The literature review searched PubMed and Cochrane databases from 2006 to 2022, focusing on studies reporting correlations between complications and treatment settings. The survey utilized a web-based questionnaire distributed to clinical sites and the international ophthalmic community, with data managed using electronic capture tools. Results: We reviewed regulations and guidelines from 23 countries across five continents, finding significant variation in IVI administration settings. In most countries, IVI is primarily administered in outpatient clean rooms (96%) or offices (39%), while in others, it is restricted to ambulatory surgery rooms or hospital-based operating theatres (4%). The literature review found that endophthalmitis risk after IVI is generally low (0.01% to 0.26% per procedure), with no significant difference between office-based and operating room settings. The international survey (20 centers, 96,624 anti-VEGF injections) found low overall incidences of severe perioperative systemic adverse events and endophthalmitis, independent of injection settings. Conclusion: No significant differences in perioperative complications were observed among various settings, including operating theatres, ambulatory surgery rooms, offices, hospitals, or extra-hospital environments. Choosing the appropriate clinical setting can optimize patient management, potentially increasing effectiveness, quality, productivity, and capacity.
AB - Purpose: This study reviews evidence and provides recommendations for the ideal setting of intravitreal injection (IVI) administration of vascular endothelial growth factor (VEGF) inhibitors. Methods: A multi-step approach was employed, including content analysis of regulations and guidelines, a systematic literature review, and an international survey assessing perioperative complications and endophthalmitis incidence in relation to injection settings. The literature review searched PubMed and Cochrane databases from 2006 to 2022, focusing on studies reporting correlations between complications and treatment settings. The survey utilized a web-based questionnaire distributed to clinical sites and the international ophthalmic community, with data managed using electronic capture tools. Results: We reviewed regulations and guidelines from 23 countries across five continents, finding significant variation in IVI administration settings. In most countries, IVI is primarily administered in outpatient clean rooms (96%) or offices (39%), while in others, it is restricted to ambulatory surgery rooms or hospital-based operating theatres (4%). The literature review found that endophthalmitis risk after IVI is generally low (0.01% to 0.26% per procedure), with no significant difference between office-based and operating room settings. The international survey (20 centers, 96,624 anti-VEGF injections) found low overall incidences of severe perioperative systemic adverse events and endophthalmitis, independent of injection settings. Conclusion: No significant differences in perioperative complications were observed among various settings, including operating theatres, ambulatory surgery rooms, offices, hospitals, or extra-hospital environments. Choosing the appropriate clinical setting can optimize patient management, potentially increasing effectiveness, quality, productivity, and capacity.
KW - Ambulatory surgery room
KW - Endophthalmitis
KW - In-office
KW - Intravitreal injection
KW - Operating theatre
KW - Setting
UR - http://www.scopus.com/inward/record.url?scp=85159803407&partnerID=8YFLogxK
U2 - 10.1007/s00417-023-06108-y
DO - 10.1007/s00417-023-06108-y
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C2 - 37199802
AN - SCOPUS:85159803407
SN - 0721-832X
VL - 261
SP - 3299
EP - 3306
JO - Graefe's Archive for Clinical and Experimental Ophthalmology
JF - Graefe's Archive for Clinical and Experimental Ophthalmology
IS - 11
ER -