The ideal intravitreal injection setting: office, ambulatory surgery room or operating theatre? A narrative review and international survey

Società Italiana della Retina (SIR) Study Group, Intravitreal Injection Setting Study Group (I2SG)

Research output: Contribution to journalShort surveypeer-review


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.

Original languageEnglish
Pages (from-to)3299-3306
Number of pages8
JournalGraefe's Archive for Clinical and Experimental Ophthalmology
Issue number11
StatePublished - Nov 2023


  • Ambulatory surgery room
  • Endophthalmitis
  • In-office
  • Intravitreal injection
  • Operating theatre
  • Setting


Dive into the research topics of 'The ideal intravitreal injection setting: office, ambulatory surgery room or operating theatre? A narrative review and international survey'. Together they form a unique fingerprint.

Cite this