title: Survey of intravitreal injection techniques and treatment protocols among retina specialists in Canada.
abstract: OBJECTIVE
  To describe intravitreal injection (IVI) techniques and treatment protocols by retina specialists in Canada from August 1, 2012, to October 1, 2012.
  
  
  METHODS
  Cross-sectional survey.
  
  
  METHODS
  All fellowship-trained retina specialists across Canada, as identified from the Canadian Ophthalmological Society directory and the Canadian Retina and Vitreous Society directory.
  
  
  METHODS
  An anonymous 28-question survey was sent to 125 retina specialists across Canada by email. Reminder letters were sent by email, mail, and fax as necessary.
  
  
  RESULTS
  A total of 75 (63%) retina specialists responded to the survey. Most IVIs were performed in the office. Most surgeons did not use gloves (61%), sterile draping (91%), or surgical mask (71%). Antisepsis was used on conjunctiva by 100% and on periocular skin by 48%. Nearly all specialists used a sterile lid speculum (91%). Common anaesthetics included topical proparacaine or lidocaine drops (90%), topical lidocaine gel (25%), topical pledget (23%), and subconjunctival lidocaine injections (23%). Most (83%) dilate the pupil before IVI. Prophylactic topical antibiotics were used by 43%; 50% of these were started immediately after IVI. Injection location was estimated by visualization by 45%. A majority (63%) inject inferotemporally. Anterior chamber paracentesis was performed routinely by 5%. Optic nerve perfusion was formally assessed by 48%. The most common treatment protocol for age-related macular degeneration was treat and extend. For both diabetic and retinal vein occlusion-related macular edema, the most common protocol was 3 initial monthly injections with PRN follow-up.
  
  
  CONCLUSIONS
  A wide variety of IVI practice patterns exist in terms of aseptic technique, anaesthetics, prophylactic antibiotics, postinjection monitoring, and treatment protocol.
authors.affiliation: Department of Ophthalmology, Queen's University, Kingston, ON.
authors.forename: Lin
authors.initials: L
authors.lastname: Xing
authors.affiliation: Department of Ophthalmology, Queen's University, Kingston, ON. Electronic address: 11sjd1@queensu.ca.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Dorrepaal
authors.affiliation: Department of Ophthalmology, Queen's University, Kingston, ON.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Gale
mesh_terms: D000287:Administration, Topical; D000772:Anesthesia, Local / Q000706:statistics & numerical data; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002170:Canada; D002985:Clinical Protocols; D003430:Cross-Sectional Studies; D005260:Female; D006306:Health Surveys; D006801:Humans; D058449:Intravitreal Injections / Q000379:methods* / Q000706:statistics & numerical data; D008268:Macular Degeneration / Q000188:drug therapy; D008269:Macular Edema / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009883:Ophthalmic Solutions / Q000008:administration & dosage*; D009885:Ophthalmology; D010818:Practice Patterns, Physicians'; D012160:Retina; D012164:Retinal Diseases / Q000188:drug therapy*; D012170:Retinal Vein Occlusion / Q000188:drug therapy; D013038:Specialization; D011795:Surveys and Questionnaires
chemical_list: D000900:Anti-Bacterial Agents; D009883:Ophthalmic Solutions