title: Non-physician delivered intravitreal injection service is feasible and safe - a systematic review.
abstract: BACKGROUND
  Non-physicians such as nurses are trained to give injections into the vitreous body of the eye to meet the increasing demand for intravitreal therapy with vascular endothelial growth factor inhibitors against common eye diseases, e.g. age-related macular degeneration and diabetic retinopathy. We systematically reviewed the existing literature to provide an overview of the experiences in this transformational process.
  
  
  METHODS
  We searched for literature on 22 September 2015 using PubMed, Embase, the Cochrane Library, CINAHL and the Web of Science. Eligible studies had to address any outcome based on non-physician delivered intravitreal therapy regardless of the study design. Being non-physician was defined as the injecting personnel not being a physician, but no further restrictions were made.
  
  
  RESULTS
  Five studies were included with a total of 31,303 injections having been performed by 16 nurses. The studies found that having nurses perform the intravitreal injections produced to a short-term capacity improvement and liberated physicians for other clinical work. Training was provided through courses and direct supervision. The rates of endophthalmitis were 0-0.40‰, which is comparable to reported rates when the intravitreal therapy is given by physicians.
  
  
  CONCLUSIONS
  Non-physician delivered intravitreal therapy seems feasible and safe.
authors.affiliation: ysubhi@gmail.com.
authors.forename: Asrin
authors.initials: A
authors.lastname: Rasul
authors.forename: Yousif
authors.initials: Y
authors.lastname: Subhi
authors.forename: Torben Lykke
authors.initials: TL
authors.lastname: Sørensen
authors.forename: Inger Christine
authors.initials: IC
authors.lastname: Munch
mesh_terms: D002908:Chronic Disease / Q000628:therapy; D032022:Delegation, Professional; D006801:Humans; D058449:Intravitreal Injections / Q000379:methods / Q000451:nursing* / Q000706:statistics & numerical data; D009885:Ophthalmology / Q000193:education*; D012164:Retinal Diseases / Q000188:drug therapy*; D042442:Vascular Endothelial Growth Factors / Q000008:administration & dosage*
chemical_list: D042442:Vascular Endothelial Growth Factors