Intravitreal injection of triamcinolone, Anti VEGF & antibiotics are given in various retinal conditions. It may be a single or multiple injections at one time depending on the retinal condition. It was found that during injection increased IOP may lead to compromised optic disc perfusion & vitreous incarceration in needle track after its removal & subconjunctival vitreous.To have a safe intravitreal injection we have devised a simple but very helpful technique to lessen the IOP.One or many intravitreal medicines can be injected without any rise in IOP or vitreous incarceration or any subconjunctival vitreous.A 26 or 30 G needle hub is mounted on sterile ear bud to obstruct its inner hole, then it is pierced horizontally into the anterior chamber till its bevel is half in AC & not surpassing pupil border so that lens touch is avoided.Now intravitreal injection one or many drugs are given without any fear of rise in IOP.As soon as the medicine is injected,the extrafluid (aqueous) comes out through needle & soaked in the sterile ear bud. After removal of intravitreal needle no vit incarceration or subconjunctival vitreous were noted,IOP remains stable. Dramatically less pain was noted. At the end you find stable AC & IOP without any complications.

1. Intravitreal InjectionIntravitreal Injection
--InnovativeInnovative
TechniqueTechnique
DR. SANTOSH AGRAWAL
AURANGABAD, MAHARASHTRA
MOB- 09325382000/09689360352
EMAIL-drsantoshagrawal@gmail.com

2.  Intravit. Injection is now widely used to administerIntravit. Injection is now widely used to administer
• Anti VEGF , Triamcinolone acetonide,
Antibiotics,TPA etc.
• Chances of iris or lens touch can be avoided by
penetrating needle at limbus tangentially into AC
just the bevel is partially inside the AC and not
touching any intraocular structures
IntroductionIntroduction

3. Risks of Intravit. Injection Technique
 Vitreous incarceration
 “Vitreous wick” through scleral tunnel
 A bleb formation
 Immediate increase IOP
 Transient CRA occlusion – sudden central black out
 Increse risk of endop. b/o bact. Entering through
injection site
 RD because of vitreous traction

4. My Simple & Novel AC
Paracentesis Device
 “Prior (Pre injection)
paracentesis with a 26/30 G
needle whose hub is mounted
on a sterile Johnson bud”.
 It remains inside AC throughout
the injection to drain out
aqueous as the intraocular
volume increases.

5. Advantages
 No immediate hypotony or AC collapse
 At the time of injection aqueous drained out slowly – soaked into the
tip of bud.
 No immediate rise in IOP
 Multiple injections can be given.
 No vitreous or drug reflux at the site of injection
 No vitreous wick
 Less chances of endophthalmitis
 Practically no need to check fundus or vision (post injection)
 Less discomfort to patient as no sudden increase IOP

6. MATERIAL AND METHOD
ETHICAL STANDERD OUTLINED BY MRC WERE FOLLOWEDETHICAL STANDERD OUTLINED BY MRC WERE FOLLOWED
Informed comment was taken.
Mean duration of follow up 48mts ±6.
Main outcome measures studied
Vit. incarceration , vit wick, vit reflex , bleb formation
ERA pulsation,iop,ant.chamber complications, pain
Duration of study – 5 years (From Feb 2011 to Feb 2016)
Cases – 320

7. Intravit Injections
 AntiVEGF – Avastin 0.05 ml – 152
 T.A. – 112 eyes
 Antibiotics for endophthalmitis – 54
 Others – TPA – 2
 Preop. betadine e/d
 In OT, painting & drapping
 Topical anaesthesia by paracain
 Caliper used :
- 3-3.5 mm in pseudophakia
- 3.5 to 4 mm in phakic eye
 26 G or 30 G needle on tuberculin syringe
 Preinjection paracentesis by new device.

8. RESULT
COMPLICATIONS
PRESENT
SDTUDIES
BLEB FORMATION 0.80 %
FUNDUS CRA PULSATION 1.61 %
VIT . INCARERATION (VIT WICK) 0.40 %
RD NIL
PAIN DURING PROCEDURE 1.2 %
ENDOOPTHALMITIS NIL

9. COMPLICATIONS
PRESENT
SDTUDIES
OTHER SDTUDIES
BLEB FORMATION 0.80 % 20 %
FUNDUS CRA PULSATION 1.61 % 30 %
VIT . INCARERATION (VIT WICK) 0.40 % 42.9 %
RD NIL 0.8 %
PAIN DURING PROCEDURE 1.2 % 80 %
ENDOOPTHALMITIS NIL 0.5 to 3 %
DISCUSSION

10. DISCUSSION
 Dramatic effect of the this new technique on
intraoperative & postop complication were
observed.
 There is hardly any bleb formation, vit. Incaration,
Rise in IOP or CRA pulsation were notified as
against other studies.
 Less or no pain was experienced may be due to no
sudden increase in IOP

11. ConclusionConclusion
This is the simple, inexpensive ACThis is the simple, inexpensive AC
Paracentesis Device Which isParacentesis Device Which is
found very safe for all types offound very safe for all types of
intravitreal injections.intravitreal injections.