Vitreo Retina

Commentary: All India Ophthalmological Society members' survey: Practice pattern of intravitreal anti-vascular endothelial growth factor injection" has been published in "Indian Journal of Ophthalmology

The strength o f the study is the large number o f specialists (741) who have responded to the questionnaire. It is interesting to note that practices like wearing of gloves, use of mask, and eye speculum is more or less a universal practice and is similar to that of developed countries.[1,2] It further emphasizes that ophthalmologists in India are conscious of sterile practices. Some of the practices like use of prophylactic antibiotics and post‑treatment antibiotics are also similar to what is followed in the US and UK.[1,2] The survey surprisingly does not mention about the use of topical povidone–iodine prior to the injection which I feel is a universal practice. It would have been interesting if the survey had looked into certain important aspects regarding the injection techniques viz.
(a) Size of needle used
(b) Displacement of the conjunctiva at the time of injection
(c) Quadrant used for performing the injection
(d) Paracentesis at the end of the procedure
(e) Is checking the peripheral retina a routine practice prior to the injection
(f) Does the ophthalmologists check forretinal perfusion at the end of the procedure
(g) Is pupillary dilatation a routine practice priorto the injection
(h) Bilateral simultaneous injection – is it a practice in our country as it is very common in the UK and nearly 40% of the respondents in the US perform bilateral injection.[3]
(i) Whatis an average time gap when both eyes need treatment?
(j) When do ophthalmologists examine the patient after the injection procedure?

The survey has looked into the injection practices for use of bevacizumab (Avastin). This is a very important contribution. In spite of the recommendations of AIOS–VRSI guidelines,[4] there are still a sizeable number of ophthalmologists who are following the multiple puncture technique. It is also disheartening to note that 1/5th of the respondents are storing the open vials and loaded syringes up to one month in the refrigerator. In a developing country like ours bevacizumab will continue to be an important anti‑VEGF agent in vitreo retina practice and although aliquoting techniques are difficult we need to be careful to prevent post‑injection endophthalmitis. In a recent report from our center where we evaluated 3806 injections of bevacizumab with proper aliquoting technique, the incidence of endophthalmitis was only 0.08%.[5]