title: Survey of intravitreal injection techniques among retina specialists in Israel.
abstract: OBJECTIVE
  The purpose of this study was to describe antivascular endothelial growth factor intravitreal injection techniques of retinal specialists in order to establish a cornerstone for future practice guidelines.
  
  
  METHODS
  All members of the Israeli Retina Society were contacted by email to complete an anonymous, 19-question, Internet-based survey regarding their intravitreal injection techniques.
  
  
  RESULTS
  Overall, 66% (52/79) completed the survey. Most (98%) do not instruct patients to discontinue anticoagulant therapy and 92% prescribe treatment for patients in the waiting room. Three quarters wear sterile gloves and prepare the patient in the supine position. A majority (71%) use sterile surgical draping. All respondents apply topical analgesics and a majority (69%) measure the distance from the limbus to the injection site. A minority (21%) displace the conjunctiva prior to injection. A majority of the survey participants use a 30-gauge needle and the most common quadrant for injection is superotemporal (33%). Less than half routinely assess postinjection optic nerve perfusion (44%). A majority (92%) apply prophylactic antibiotics immediately after the injection.
  
  
  CONCLUSIONS
  The majority of retina specialists perform intravitreal injections similarly. However, a relatively large minority performs this procedure differently. Due to the extremely low percentage of complications, it seems as though such differences do not increase the risk. However, more evidence-based medicine, a cornerstone for practice guidelines, is required in order to identify the intravitreal injection techniques that combine safety and efficacy while causing as little discomfort to the patients as possible.
authors.affiliation: Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel; The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Ori
authors.initials: O
authors.lastname: Segal
authors.affiliation: Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel; Department of Psychiatry, Geha Psychiatric Hospital, Petah Tikva, Israel.
authors.forename: Yael
authors.initials: Y
authors.lastname: Segal-Trivitz
authors.affiliation: Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel; The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Arie Y
authors.initials: AY
authors.lastname: Nemet
authors.affiliation: Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel; The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Noa
authors.initials: N
authors.lastname: Geffen
authors.affiliation: Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel; The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Ronit
authors.initials: R
authors.lastname: Nesher
authors.affiliation: Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Michael
authors.initials: M
authors.lastname: Mimouni
keywords: injection; intravitreal; patterns; practices; retina; techniques