Patient-Reported Complications after Intravitreal Injection and Their Predictive Factors

• Authors: Michael S. Ramos, Cleveland Clinic Foundation; Lucy T. Xu, Emory University; Srinidhi Singuri, Cleveland Clinic Foundation; Julio C. Castillo Tafur, Cleveland Clinic Foundation; Sruthi Arepalli, Cleveland Clinic Foundation; Justis P. Ehlers, Cleveland Clinic Foundation; Peter K. Kaiser, Cleveland Clinic Foundation; Rishi P. Singh, Cleveland Clinic Foundation; Aleksandra V. Rachitskaya, Cleveland Clinic Foundation; Sunil K. Srivastava, Cleveland Clinic Foundation; Jonathan E. Sears, Cleveland Clinic Foundation; Andrew P. Schachat, Cleveland Clinic Foundation; Amy S. Babiuch, Cleveland Clinic Foundation; Sumit Sharma, Cleveland Clinic Foundation; Daniel F. Martin, Cleveland Clinic Foundation; Careen Y. Lowder, Cleveland Clinic Foundation; Arun D. Singh, Cleveland Clinic Foundation; Alex Yuan, Cleveland Clinic Foundation; Amy S. Nowacki, Cleveland Clinic Foundation
• Journal Title: Ophthalmology Retina
• Volume: Volume 5, Number 7
• Publisher: Elsevier | 2021-07-01, Pages 625-632
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1016/j.oret.2020.09.024
• Subjects: Gerontology; Health Sciences, Opthamology
• Keywords: Complications; Intravitreal injection; Predictive factors; Retrospective; Aged; Aged, 80 and over; Angiogenesis Inhibitors; Female; Follow-Up Studies; Humans; Intravitreal Injections; Male; Patient Reported Outcome Measures; Retinal Diseases; Retrospective Studies; Visual Acuity

Abstract

Purpose: 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. Design: Retrospective, institutional review board–approved study. Participants: Forty-four thousand seven hundred thirty-four injections in 5318 unique patients at the Cleveland Clinic Cole Eye Institute from 2012 through 2016. Methods: Intravitreal injection. Main Outcome Measures: Complication occurrence within 15 days of injection. Results: 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. Conclusions: 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.