Tape, fix, and inject: a novel one-person technique of intravitreal injection for the treatment of retinopathy of prematurity under topical anesthesia

Abstract

Aim The purpose of this study was to describe and evaluate a novel one-person intravitreal injection (IVI) technique for the treatment of retinopathy of prematurity (ROP) under topical anesthesia. Patients and methods This is a retrospective study that was conducted on 44 babies who had IVI for the treatment of severe ROP under topical anesthesia. The swaddled baby’s head and body were fixed to the operating table with strips of adhesive tape, obviating the need for an assistant to hold the baby still. The calibers were used both to fix the globe and to determine the site of the injection by measuring the distance of 1.5 mm from the limbus. Results The mean gestational age of the patients was 29.6±1.5 weeks, with a mean birth weight of 1085.2±239.4 g. The mean procedure duration (between the insertion of the lid speculum at the beginning of the procedure and its removal at the end) for the right eye (64.9±15.6 s) was less than for the left eye (66.4±15.1 s), but the difference was not statistically significant (P=0.29). Inadvertent head movements occurred in 2 (4.5%) cases, with a large postmenstrual age of 37 and 38 weeks at treatment. None of the cases had inadvertent eye movements. Conclusion The technique seems safe and effective, especially in patients with a smaller postmenstrual age at the time of the injection. Additional care should be taken during taping of the head and the body in larger babies. Alternatively, giving sedation or general anesthesia may be a safer option.

Keywords

• infant stress
• intravitreal injection
• ranibizumab
• retinopathy of prematurity
• topical anesthesia