Intravitreal air bubbles following intravitreal injections: a comprehensive analysis

Area of Science:

• Ophthalmology
• Retinal Diseases
• Vascular Endothelial Growth Factor (VEGF) Therapy

Background:

• Intravitreal injections of anti-VEGF agents are standard for retinal diseases.
• Residual air bubbles post-injection can cause patient discomfort and visual disturbances.

Purpose of the Study:

• To determine the prevalence of air bubbles after anti-VEGF intravitreal injections.
• To compare two techniques for reducing air bubble formation: "upwards" vs. "downwards" syringe tapping.
• To assess the impact of different anti-VEGF drugs and pre-filled syringes on air bubble rates.

Main Methods:

• 344 intravitreal injections were analyzed, with 172 using each technique.
• Patients reported air bubble presence and resolution times.
• Syringe tapping techniques (upwards vs. downwards) and drug types (ranibizumab, bevacizumab, aflibercept) were compared.

Main Results:

• Overall residual air bubble rate was 11.3%, with 94.9% resolving within 48 hours.
• The "downwards" tapping technique showed a significantly lower rate (7.5%) compared to the "upwards" technique (15.1%).
• Pre-filled syringes with ranibizumab had a significantly lower rate (0%) than bevacizumab and aflibercept (12.1%-14.7%).

Conclusions:

• Residual air bubbles are frequent after anti-VEGF intravitreal injections.
• The "downwards" tapping technique and pre-filled syringes are effective in reducing air bubble incidence.
• Minimizing air bubbles is important for patient comfort and visual outcomes.