Veritti Daniele, Sarao Valentina, Chhablani Jay, Loewenstein Anat, Lanzetta Paolo
Department of Medicine - Ophthalmology, University of Udine, Piazzale Santa Maria Della Misericordia, 33100, Udine, Italy.
Istituto Europeo Di Microchirurgia Oculare - IEMO, Udine, Italy.
Graefes Arch Clin Exp Ophthalmol. 2023 Nov;261(11):3299-3306. doi: 10.1007/s00417-023-06108-y. Epub 2023 May 18.
This study reviews evidence and provides recommendations for the ideal setting of intravitreal injection (IVI) administration of vascular endothelial growth factor (VEGF) inhibitors.
A multi-step approach was employed, including content analysis of regulations and guidelines, a systematic literature review, and an international survey assessing perioperative complications and endophthalmitis incidence in relation to injection settings. The literature review searched PubMed and Cochrane databases from 2006 to 2022, focusing on studies reporting correlations between complications and treatment settings. The survey utilized a web-based questionnaire distributed to clinical sites and the international ophthalmic community, with data managed using electronic capture tools.
We reviewed regulations and guidelines from 23 countries across five continents, finding significant variation in IVI administration settings. In most countries, IVI is primarily administered in outpatient clean rooms (96%) or offices (39%), while in others, it is restricted to ambulatory surgery rooms or hospital-based operating theatres (4%). The literature review found that endophthalmitis risk after IVI is generally low (0.01% to 0.26% per procedure), with no significant difference between office-based and operating room settings. The international survey (20 centers, 96,624 anti-VEGF injections) found low overall incidences of severe perioperative systemic adverse events and endophthalmitis, independent of injection settings.
No significant differences in perioperative complications were observed among various settings, including operating theatres, ambulatory surgery rooms, offices, hospitals, or extra-hospital environments. Choosing the appropriate clinical setting can optimize patient management, potentially increasing effectiveness, quality, productivity, and capacity.
本研究回顾相关证据，并为玻璃体内注射血管内皮生长因子（VEGF）抑制剂的理想给药环境提供建议。
采用多步骤方法，包括对法规和指南进行内容分析、系统的文献综述以及一项国际调查，该调查评估与注射环境相关的围手术期并发症和眼内炎发生率。文献综述检索了2006年至2022年的PubMed和Cochrane数据库，重点关注报告并发症与治疗环境之间相关性的研究。该调查使用基于网络的问卷分发给临床机构和国际眼科界，并使用电子采集工具管理数据。
我们回顾了五大洲23个国家的法规和指南，发现玻璃体内注射给药环境存在显著差异。在大多数国家，玻璃体内注射主要在门诊洁净室（96%）或办公室（39%）进行，而在其他国家，则限于门诊手术室或医院手术室（4%）。文献综述发现，玻璃体内注射后眼内炎风险通常较低（每次手术0.01%至0.26%），基于办公室的环境和手术室环境之间无显著差异。国际调查（20个中心，96624次抗VEGF注射）发现，严重围手术期全身不良事件和眼内炎的总体发生率较低，与注射环境无关。
在包括手术室、门诊手术室、办公室、医院或院外环境等各种环境中，围手术期并发症未观察到显著差异。选择合适的临床环境可优化患者管理，可能提高有效性、质量、生产力和能力。
