Patient-Reported Complications after Intravitreal Injection and Their Predictive Factors

Abstract

Objective The intravitreal injection (IVI) of pharmacological agents is the most commonly performed ocular procedure and is associated with a host of complications. The majority of IVI-related complications data is derived from randomized controlled clinical trials, which report a high adverse event rate. The nature of these protocol-driven trials limit their applicability to the diverse circumstances seen in routine clinical practice. The goal of this study is to determine the prevalence of patient reported IVI-related complications, their risk factors, and the manner in which patients presented in a tertiary eye care center. Design A retrospective, IRB-approved review. Subjects, Participants and/or Controls 44,734 injections in 5,318 unique patients at the Cleveland Clinic Cole Eye Institute from 2012-2016. Methods, Intervention, or Testing Intravitreal injection. Main Outcome Measures Complication occurrence within 15 days of injection. Results From 2012-2016, a total of 44,734 injections were performed in 5,318 unique patients. Overall, complication rates were low, representing 1.9% of all injections, with 1031 unique complications in 685 (12.9%) patients. The most common minor complications, or those not requiring intervention, were irritation (n=312) and subconjunctival hemorrhage (n=284). The most common serious complications, or those requiring intervention, were corneal abrasion (n=46) and iritis (n=31). The majority of complications (66%) were adequately managed by a telephone/Epic electronic message encounter only. Importantly, no injection protocol parameter, such as type of anesthesia, preparation, or post-injection medication, increased the risk of a complication. However, patient sex, age, number of previous injections, and provider strongly influenced the risk of patient-reported complications. Conclusions Overall, complication rates seen in routine clinical practice were low compared to clinical trial reporting. Providers should feel confident in the safety and administration of IVI during times when follow-up office visits and resources may be limited. When performing an IVI, factors such as a patient’s sex, age, number of previous injections, and provider must be taken into account to ensure the best possible outcomes.

Posterior cyclodialysis cleft following intravitreal injection

“…According to prior studies, the overall rates of serious adverse ocular complications--including cataract, vitreous hemorrhage following IVI, and reduction in best-corrected visual acuity--following intravitreal injections are under 10%. 7 , 9 , 10 Hypotony following IVI is even more rare; here we report the first case of a posterior cleft following intravitreal injection.…”

“…Visually devastating complications including intraocular hemorrhage, retinal detachment, and endophthalmitis are rare. 6 , 7 , 8 …”

The Challenges of Treating Neovascular Age-Related Macular Degeneration

“…Apart from the issue of the response to injection therapy, the associated risks and possible complications must not be overlooked. Minor complications reported by patients in connection with injection therapy include eye irritation, subconjunctival haemorrhage and visual disturbance from the medication or air bubbles [25]. The main serious complications that should be mentioned are increased intraocular pressure after injection, corneal abrasion, retinal detachment, vitreous or retinal haemorrhage and endophthalmitis [25,26].…”

Intravitreal Injection Therapy: Current Techniques and Supplemental Services

“…This lowers the risk of endophthalmitis as well as various traumatic complications, including cataract, 29 RD, 11 and corneal abrasion. 30 The head is positioned firmly against a support, such as a pillow or headrest on the back of an examination chair or procedure table, and the patient should be well supported and comfortable when in the reclined position. Having patients and proceduralists wear masks and limit speaking during the procedure may decrease exposure to bacterial contamination.…”