Abstract

FR.21.10

Incidence of damage to the crystalline lens and retina during intravitreal injections

Nina Kosanetzky1, Stephan Michels2, Hans-Martin Helb1, Stefan Mennel3, Jörg C. Schmidt4, Nicole Eter1, Eduardo B. Rodrigues5, Frank G. Holz1, Carsten H. Meyer1
1Universitäts-Augenklinik Bonn, 2Augenklinik der Universität Zürich, Schweiz; 3Universitäts-Augenklinik Marburg; 4Augenklinik, Tausend Fensterhaus, Duisburg, 5Vision Institut (IPEPO) Federal University of São Paulo, Brazil

Purpose
To report the incidence of traumatic lens injuries and retinal detachments (RD) as a complication of intravitreal injection
Methods
A retrospective study determined the consecutive number of the injections between January 5, 2006 to December 22, 2008. All injections were performed under sterile conditions in a laying position, 3.5 to 4.0 mm behind the limbus in an oblique fashion. The main outcome measure was the incidence of lens damage and RD.
Results
A total of 32318 intravitreal injections were performed and three cases of iatrogenic lens damage and 4 retinal detachments were reported.  RD occurred in two myopic eyes and 2 vitreous haemorrhages.  All lens damages occurred in hyperopic eyes. The overall incidence rate of lens injury was 0.009% (3/32318) for intravitreal injections. The rate of phakic eyes determined was 67%, and thus, the incidence rate of lens damage in phakic eyes was 0.013% (3/21653) (95% confidence interval, 0.00% to 0.05%). 
Conclusions
Although there is no consensus regarding the intravitreal injection procedure technique, the incidence of traumatic injuries to the crystalline lens was very low in a large series of injected patients in a community setting. The incidence compares favourably with that reported in clinical trials where much more extensive preinjection preparation was mandated.  A good preparation of the surgical incision with proper anaesthesia and detailed information of the patient, as well as good anatomical skills of the treating physician, are mandatory to prevent this rare adverse event.

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