title: Safety of bilateral intravitreal injections delivered in a teaching institution.
abstract: Intravitreal injection is one of the most common in-office procedures performed in ophthalmic practices. In teaching institutions such as the Veterans Affairs (VA) Hospitals, patient care is delivered by physicians-in-training, while mastering intravitreal injection technique. Infectious endophthalmitis and visual loss are the most feared complications of intravitreal injections, especially in the context of recent outbreaks caused by contaminated compounded medications. Ophthalmologists and ophthalmic educators increasingly face the dilemma of timing as well as balancing the risks and benefits of bilateral treatments required by many patients. In this editorial, we discuss published reports of bilateral injections, summarize our experience with bilateral intravitreal injections in a teaching setting at the Miami VA Hospital and list our recommendations for minimizing the risk of infectious endophthalmitis.
authors.affiliation: Miami Veterans Affairs Medical Center , Miami, FL , USA.
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Chao
authors.forename: Ninel Z
authors.initials: NZ
authors.lastname: Gregori
authors.forename: Joyce
authors.initials: J
authors.lastname: Khandji
authors.forename: Raquel
authors.initials: R
authors.lastname: Goldhardt
mesh_terms: D020533:Angiogenesis Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects*; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000009:adverse effects; D000068258:Bevacizumab; D004503:Education, Medical, Graduate; D009877:Endophthalmitis / Q000517:prevention & control*; D015818:Eye Infections, Bacterial / Q000517:prevention & control*; D006784:Hospitals, Teaching; D006787:Hospitals, Veterans; D006801:Humans; D007396:Internship and Residency; D058449:Intravitreal Injections; D009885:Ophthalmology / Q000193:education; D000069579:Ranibizumab; D040262:Receptors, Vascular Endothelial Growth Factor / Q000008:administration & dosage / Q000009:adverse effects; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage / Q000009:adverse effects; D012164:Retinal Diseases / Q000188:drug therapy*; D014481:United States
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D011993:Recombinant Fusion Proteins; C533178:aflibercept; D000068258:Bevacizumab; D040262:Receptors, Vascular Endothelial Growth Factor; D000069579:Ranibizumab
keywords: Veterans Affairs hospital; aflibercept; anti-VEGF; bevacizumab; bilateral intravitreal injection; ophthalmology resident; ranibizumab; teaching institution