Patient-Reported Complications after Intravitreal Injection and Their Predictive Factors

• DOI: 10.1016/j.oret.2020.09.024
• Publication Date: 2020-10-12T05:51:40Z
• Authors: Michael S. Ramos; Lucy T. Xu; Srinidhi Singuri; Julio C. Castillo...; Sruthi Arepalli; Justis P. Ehlers; Peter K. Kaiser; Rishi P. Singh; Aleksandra V. Rac...; Sunil K. Srivastava; Jonathan E. Sears; Andrew P. Schachat; Amy S. Babiuch; Sumit Sharma; Daniel F. Martin; Careen Y. Lowder; Arun D. Singh; Alex Yuan; Amy S. Nowacki
• Keywords: Aged, 80 and over; Male; 0301 basic medicine; Visual Acuity; Angiogenesis Inhibitors; 3. Good health; 03 medical and health sciences; Retinal Diseases; Intravitreal Injections; Humans; Original Article; Female; Patient Reported Outcome Measures; Aged; Follow-Up Studies; Retrospective Studies

The intravitreal injection (IVI) of pharmacologic agents is the most commonly performed ocular procedure and is associated with a host of complications. Most IVI-related complications data are 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 was to determine the prevalence of patient-reported IVI-related complications, their risk factors, and the manner in which patients sought treatment at a tertiary eye care center.Retrospective, institutional review board-approved study.Forty-four thousand seven hundred thirty-four injections in 5318 unique patients at the Cleveland Clinic Cole Eye Institute from 2012 through 2016.Intravitreal injection.Complication occurrence within 15 days of injection.From 2012 through 2016, a total of 44734 injections were performed in 5318 unique patients. Overall, complication rates were low, representing 1.9% of all injections, with 1031 unique complications in 685 patients (12.9%). 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). Most complications (66%) were managed adequately by a telephone or Epic (Epic Systems Corp., Verona, WI) 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, a patient's gender, age, number of previous injections, and provider strongly influenced the risk of patient-reported complications.Overall, complication rates seen in routine clinical practice were low compared with 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 gender, age, number of previous injections, and provider must be taken into account to ensure the best possible outcomes.