title: Intravitreal injection technique and monitoring: updated guidelines of an expert panel.
abstract: OBJECTIVE
  To review evidence and provide updated guidelines on intravitreal (IVT) injection technique and monitoring.
  
  
  METHODS
  A review of the published literature on IVT injection from 2004 to 2014 formed the basis for round table deliberations by an expert panel of ophthalmologists.
  
  
  RESULTS
  The dramatic increase in the number of IVT injections has been accompanied by a comparable increase in evidence surrounding IVT practice patterns and techniques. The expert panel identified a number of areas that have evolved since publication of the original IVT injection guidelines in 2004, the most notable of which were a lack of evidence to support the routine use of pre-, peri-, and postinjection antibiotics to reduce the risk of endophthalmitis, and the role of aerosolized droplets containing oral contaminants from the patient and/or providers as a potential source of infection. The panel emphasized the continued importance of applying povidone-iodine to and avoiding eyelid contact with the intended injection site and needle.
  
  
  CONCLUSIONS
  Updated guidelines on IVT injection technique and monitoring are proposed based on a review of published literature and expert panel deliberations.
authors.affiliation: *California Retina Consultants and Research Foundation, Santa Barbara, California; †Mayo Clinic, Rochester, Minnesota; ‡Byers Eye Institute, Stanford University School of Medicine, Stanford, California; §Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; ¶California Pacific Medical Center, San Francisco, California; **The Francis I. Proctor Foundation, UCSF School of Medicine, San Francisco, California; ††West Coast Retina, San Francisco, California; ‡‡Weill Cornell Medical College, New York-Presbyterian Medical Center, New York, New York; §§Keck School of Medicine, University of Southern California, Los Angeles, California; ¶¶Bascom Palmer Eye Institute, University of Miami, Miami, Florida; ***Vitreous-Retina-Macula Consultants of New York, New York; †††Wills Eye Hospital, Philadelphia, Pennsylvania; ‡‡‡Manhattan Eye, Ear & Throat Hospital, New York University Medical Center, New York, New York; §§§Jules Stein Eye Institute, University of California, Los Angeles, California; ¶¶¶University of Illinois, Chicago, Illinois; ****Stanford University School of Medicine, Stanford, California; and ††††Oakland University William Beaumont School of Medicine, Beaumont Eye Institute, Royal Oak, Michigan.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Avery
authors.forename: Sophie J
authors.initials: SJ
authors.lastname: Bakri
authors.forename: Mark S
authors.initials: MS
authors.lastname: Blumenkranz
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Brucker
authors.forename: Emmett T
authors.initials: ET
authors.lastname: Cunningham
authors.forename: Donald J
authors.initials: DJ
authors.lastname: DʼAmico
authors.forename: Pravin U
authors.initials: PU
authors.lastname: Dugel
authors.forename: Harry W
authors.initials: HW
authors.lastname: Flynn
authors.forename: K Bailey
authors.initials: KB
authors.lastname: Freund
authors.forename: Julia A
authors.initials: JA
authors.lastname: Haller
authors.forename: J Michael
authors.initials: JM
authors.lastname: Jumper
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Liebmann
authors.forename: Colin A
authors.initials: CA
authors.lastname: McCannel
authors.forename: William F
authors.initials: WF
authors.lastname: Mieler
authors.forename: Christopher N
authors.initials: CN
authors.lastname: Ta
authors.forename: George A
authors.initials: GA
authors.lastname: Williams
mesh_terms: D000779:Anesthetics, Local / Q000008:administration & dosage; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage; D019072:Antibiotic Prophylaxis; D006801:Humans; D058449:Intravitreal Injections / Q000379:methods*; D008991:Monitoring, Physiologic; D004364:Pharmaceutical Preparations / Q000008:administration & dosage; D014822:Vitreous Body / Q000187:drug effects*
chemical_list: D000779:Anesthetics, Local; D000891:Anti-Infective Agents, Local; D004364:Pharmaceutical Preparations