Same-Day Bilateral Intravitreal Anti-Vascular Endothelial Growth Factor Injections: Experience of a Large Canadian Retina Center

Abstract

Objective: To evaluate the outcomes and complications of bilateral same-day intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections. Methods: This is a single-center, retrospective study that included 524 eyes of 262 patients who received concomitant bilateral intravitreal anti-VEGF injections in 2016 at St. Michael’s Hospital, Toronto. If any of the patients were receiving simultaneous bilateral injections on a regular basis prior to 2016, data pertaining to previous injections were also reviewed. Everyone received bevacizumab, ranibizumab, or aflibercept in an office setting. Results: A total of 9,798 intravitreal anti-VEGF injections (4,899 bilateral injection sessions) were performed in 524 eyes of 262 patients. The average number of bilateral injection sessions per patient was 18.7 ± 14.1. Ranibizumab was the most commonly used anti-VEGF drug (83.8%). The incidence of endophthalmitis was 0.01%, and there were 2 episodes of acute intraocular inflammation among the 9,798 injections (0.02%). All 3 cases occurred after treatment with ranibizumab. There were 2 deaths (0.76%) due to nonvascular causes but no vascular related systemic adverse events were reported. Conclusions: Same-day bilateral intravitreal anti-VEGF injections present a low rate of complications and are well tolerated by patients. This safe practice may reduce the burden on the health-care system and on the patients.

<p>Evaluation of the Safety of Bilateral Same-Day Intravitreal Injections of Anti-Vascular Endothelial Growth Factor Agents: Experience of a Large Korean Retina Center</p>

“…One limitation of this study was that, although we could confirm the short-term ophthalmic side effects after injections, it was not possible to sufficiently confirm the ophthalmic side effects and systemic complications that may occur later. However, in the previous studies, the incidence of systemic side effects did not appear to be higher after bilateral injections, 14,16 and some studies have reported that the frequency of side effects with bilateral injection, such as retinal detachment and retinal pigment epithelial rupture, is the same as that with monocular injection. 14,20,24 Second, the purpose of this study was to determine the complications of bilateral injection; thus, a comparison with a monocular injection group was not performed in this study.…”

“…They reported that this frequency was similar to the frequency of endophthalmitis after conventional monocular injection (0.022% to 0.078%), indicating the safety of bilateral same-day injections. 16 However, although they analyzed a large number of ranibizumab and aflibercept injections, the number of bevacizumab injections in their study was relatively small. In this study, the results included a large number of patients who received bevacizumab injections, making it the largest number of bilateral bevacizumab injections among studies reported to date.…”

Intravitreal Injections with Vascular Endothelial Growth Factor Inhibitors: A Practical Approach

“…Same-day bilateral injections have been debated due to concerns regarding an increased risk of local and systemic complications [54]. However, from the patient's point of view, treatment of bilateral disease on different days may increase the perceived burden of treatment [34].…”

“…However, from the patient's point of view, treatment of bilateral disease on different days may increase the perceived burden of treatment [34]. Studies have investigated the safety profile of same-day bilateral injections and found that rates of endophthalmitis and systemic vascular events were comparable to those for unilateral injections [54]. It is recommended that each injection should be considered a separate procedure.…”

Evolution of and developments in simultaneous bilateral cataract surgery. Update 2020

“…Intravitreal injections (IVI) have become the most common intraocular procedure worldwide with increasing numbers every year (88). In several studies based on bilateral same-day intravitreal anti-VEGF injections, there were no cases of bilateral endophthalmitis, and the overall rate of unilateral endophthalmitis was low and comparable to prior studies of unilateral injections (89,90). The Euretina expert consensus panel recommended to treat each eye sequentially, and not reusing equipment such as the lid speculum or gloves (88).…”