OSLI Retina

July 2020

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402 Ophthalmic Surgery, Lasers & Imaging Retina | Healio.com/OSLIRetina ■ B R I E F R E P O R T ■ SAFER-ROP: Updated Protocol for Anti-VEGF Injections for Retinopathy of Prematurity Kinley D. Beck, MD; Effie Z. Rahman, MD; Anna Ells, MD; Kamiar Mireskandari, MD, PhD; Audina M. Berrocal, MD; C. Armitage Harper III, MD BACKGROUND AND OBJECTIVE: To describe a safe and dependable protocol for intravitreal injections for the treatment of retinopathy of prematurity (ROP). MATERIALS AND METHODS: SAFER is an acronym used to describe the injection protocol and in- cludes (S)hort needle (4-mm length), (A)ntiseptic/ antibiotic (5% to 10% topical betadine), (F)ollow- up (48 to 72 hours post-injection), (E)xtra attention to detail (clean environment, injection site 0.75 mm to 1.0 mm posterior to limbus), and (R)echeck (1 to 2 weeks following injection and until mature vascularization or laser). RESULTS: No cases of cataract formation, endo- phthalmitis, or vitreous hemorrhage using this technique were reported in a recent retrospective chart review. CONCLUSION: This protocol is a safe way to inject anti-vascular endothelial growth factor and to mon- itor ROP progression following injection. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:402-406.] INTRODUCTION Retinopathy of prematurity (ROP) is one of the leading, yet treatable causes of childhood blind- ness in both the United States and worldwide. 1 Its incidence is only increasing as medical advances have continued to push the age of viability to 21 weeks postmenstrual age. 2 Although laser remains the conventional treatment standard, the use of an- ti-vascular endothelial growth factor (VEGF) drugs, including bevacizumab (Avastin; Genentech, South San Francisco, CA) and ranibizumab (Lucentis; Ge- nentech, South San Francisco, CA) have demon- strated promising and improved visual outcomes with subsequent increased use. Despite improved structural outcomes from utilizing anti-VEGF drugs, complications induced by needle insertion technique include but are not limited to injury to and displacement of the crystalline lens, retina re- sulting in retinal tears, detachments, or even scleral perforations and endophthalmitis. 3 There have been many published standardized intravitreal injection techniques for adults 4,5 to ensure safe and reproducible delivery. However, standardized techniques for anti-VEGF administra- tion in ROP are lacking. For example, the BEAT- ROP study, which was the first controlled study From the Department of Ophthalmology, University of Texas Health San Antonio, San Antonio, Texas (KDB, EZR, CAH); Calgary Retina Consultants, Calgary, Canada (AE); the Department of Ophthalmology and Vision Sciences, Hospital for Sick Children and University of Toronto, Toronto, Canada (KM); the Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida (AMB); the Department of Ophthalmology, University of Texas at Austin, Dell Medical School, Austin, Texas (CAH); and Austin Retina Associates, Austin, Texas (CAH). © 2020 Beck, Rahman, Ells, et al.; licensee SLACK Incorporated. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (https://creativecommons.org/licenses/by-nc/4.0). This license allows users to copy and distribute, to remix, transform, and build upon the article non-commercially, provided the author is attributed and the new work is non-commercial. Originally submitted February 9, 2020. Revision received February 9, 2020. Accepted for publication May 27, 2020. Presented at the American Academy of Ophthalmology Conference for ROP 2018 Hot Topics on October 29, 2018, in Chicago, Illinois, and at Advances in Pediatric Retina on June 13, 2019, in Salt Lake City, Utah. The authors report no relevant financial disclosures. Address correspondence to C. Armitage Harper III, MD, Austin Retina Associates, 801 West 38th Street, Suite 200, Austin, TX 78705; email: caharper@ austinretina.com. doi: 10.3928/23258160-20200702-05

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