title: Bilateral same-session intravitreal injections of anti-vascular endothelial growth factors.
abstract: OBJECTIVE
  To document the indications, safety and possible complications of bilateral same-session intravitreal anti-vascular endothelial growth factor (VEGF) injections performed in the ophthalmic operating room.
  
  
  METHODS
  A retrospective case series study. Consecutive records of seventy four patients receiving simultaneous bilateral intravitreal injections of either ranibizumab or bevacizumab, between September 2010 and September 2013, were reviewed and the outcomes were assessed. Data collected included number of injections, indications for injections, pre-injection and post-injection visual acuity (VA), pre-injection and post-injection intraocular pressure and ocular and systemic complications/complaints after each injection.
  
  
  RESULTS
  A total of 342 injections were administered to 74 patients, with a mean of 4.62 injections per patient. Seventy-three patients received bevacizumab (Avastin; Genentech Inc., South San Francisco, California, USA) alone, and only one patient received both bevacizumab and ranibizumab (Lucentis; Genentech Inc.) distributed between the injections. Pre- and post-injection VA follow-up measurements were available for 65 patients. Mean follow up period was 22mo. The indications for initiating therapy were choroidal neovascular membrane from age-related macular degeneration (3 patients) and diabetic macular edema (71 patients). The mean Snellen VA before each injection was 6/22. The next post-injection follow-up mean Snellen VA was 6/20. One patient had a painful, culture-positive endophthalmitis in one eye 3d after bilateral bevacizumab. Another patient had a painless subconjunctival hemorrhage in one eye. No other ocular or systemic adverse side effects/complaints have been registered in this study group.
  
  
  CONCLUSIONS
  Bilateral same-session intravitreal injections using a separate povidone-iodine preparation, speculum, needle, and syringe for each eye are well-tolerated. None of the subjects in this study requested to switch to alternating unilateral injections. Proper patient counseling as to the risk of complications with this procedure is necessary.
authors.affiliation: Department of Ophthalmology, Faculty of Medicine, the University of Jordan, Amman 11118, Jordan.
authors.forename: Nakhleh E
authors.initials: NE
authors.lastname: Abu-Yaghi
authors.affiliation: Department of Ophthalmology, Faculty of Medicine, the University of Jordan, Amman 11118, Jordan.
authors.forename: Ahmed N
authors.initials: AN
authors.lastname: Shokry
authors.affiliation: Department of Ophthalmology, Faculty of Medicine, the University of Jordan, Amman 11118, Jordan.
authors.forename: Rami H
authors.initials: RH
authors.lastname: Abu-Sbeit
keywords: age-related macular degeneration; anti-vascular endothelial growth factor; diabetic macular edema; endophthalmitis; visual acuity