Intravitreal injection technique and monitoring: updated guidelines of an expert panel

Purpose To review evidence and provide updated guidelines on intravitreal (IVT) injection technique and monitoring. Methods A review of the published literature on IVT injection from 2004 to 2014 formed the basis for round table deliberations by an expert panel of ophthalmologists. Results The dramatic increase in the number of IVT injections has been accompanied by a comparable increase in evidence surrounding IVT practice patterns and techniques. The expert panel identified a number of areas that have evolved since publication of the original IVT injection guidelines in 2004, the most notable of which were a lack of evidence to support the routine use of pre-, peri-, and postinjection antibiotics to reduce the risk of endophthalmitis, and the role of aerosolized droplets containing oral contaminants from the patient and/or providers as a potential source of infection. The panel emphasized the continued importance of applying povidone-iodine to and avoiding eyelid contact with the intended injection site and needle. Conclusion Updated guidelines on IVT injection technique and monitoring are proposed based on a review of published literature and expert panel deliberations.