Current Practice Preferences and Safety Protocols for Intravitreal Injection of Anti-Vascular Endothelial Growth Factor Agents.

Purpose: To assess current practice preferences and safety measures used for intravitreal injection (IVI) of anti-vascular endothelial growth factor (VEGF) medications and to assess the variability of practice patterns between academic and nonacademic and between early- and later-career ophthalmologists.

Design: Cross-sectional survey. Participants: Practicing retina specialists who administer intravitreal anti-VEGF injections from the membership pool of the American Society of Retina Specialists.

Methods: Participants were contacted by e-mail to participate in an anonymous 31-question survey on a common online platform, SurveyMonkey. Main outcome measures: Preferred practices for various aspects of administering IVIs and adherence to the most recently published guidelines on IVI techniques.

Results: Preinjection antibiotic drops were used always or often by 10.9% (43/396) of participants. Antibiotics after injection were used always or often by 16.6% (66/398) of participants. Longer (>15 years) compared with shorter (0-15 years) duration of practice was associated with always or often instilling preinjection antibiotics (13.7% vs. 6.7%; P = 0.028), scrubbing eyelids or lashes with antiseptic (43.6% vs. 30.5%; P = 0.008), and being less likely to instill antiseptic immediately before injection (89.7% vs. 95.7%; P = 0.029). Practicing for more than 25 years was associated with always or often instilling antibiotics after injection (22.5% vs. 13.3%; P = 0.017). Academic compared with nonacademic providers were more likely to wear a cap (16.3% vs. 6.8%; P = 0.006), mask (43.0% vs. 29.9%; P = 0.022), and gloves (64.0% vs. 52.1%; P = 0.050) and to drape the patient (17.4% vs. 9.1%; P = 0.027).

Conclusions: Techniques for IVIs vary widely. Use of periprocedure antibiotics has declined, consistent with new evidence demonstrating lack of efficacy in endophthalmitis prevention as well as their potential harm. However, later-career physicians were more likely to continue to use antibiotics and other techniques advised against in the most recent recommendations of expert consensus groups in the United States and Europe. Academic practitioners were more likely to use protective wear during the procedure.