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Intravitreal air bubbles following intravitreal injections: a comprehensive analysis

  • Retinal Disorders
  • Published:
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Abstract

Purpose

To evaluate the prevalence of residual air bubbles following intravitreal injections of anti-VEGF agents, and to compare two techniques designed to reduce their occurrence.

Methods

Patients who received intravitreal injections reported the presence of air bubbles following the procedure, and were followed to determine when they disappeared. Two techniques used to reduce air bubbles prior to injection were compared—tapping the syringe with the needle up (“upwards” technique) or down (“downwards” technique). Rates of residual air bubbles were compared between techniques, and between different drugs.

Results

The study included 344 intravitreal injections, 172 injected with each technique. The overall rate of residual air bubbles was 11.3%, with 94.9% resolution by 48 h. The rate was significantly lower with the “downwards” technique (7.5% vs. 15.1%, p = 0.027). It was also significantly lower with ranibizumab injected using pre-filled syringes than with bevacizumab and aflibercept (0% vs. 12.1% and 14.7%, p < 0.0001). A questionnaire revealed patients reported medium levels of discomfort and a high importance of avoiding air bubbles.

Conclusions

Residual air bubbles are a common occurrence, likely to be experienced by most patients undergoing repeated injections. This phenomenon may be significantly reduced by using the described “downwards” technique, or pre-filled syringes.

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Data availability

Data is available upon request. No code was used.

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Author information

Authors and Affiliations

  1. Department of Ophthalmology, Tel Aviv Medical Center, Tel Aviv, Israel

    Mark Krauthammer & Etty Trabelsi

  2. Department of Ophthalmology, Meir Medical Center, 59 Tshernichovsky St, 4428164, Kfar Saba, Israel

    Elad Moisseiev

  3. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    Elad Moisseiev

Authors
  1. Mark Krauthammer
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  2. Etty Trabelsi
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  3. Elad Moisseiev
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Contributions

Research design: EM, MK.

Data acquisition: ET, MK.

Data analysis: EM.

Manuscript preparation: EM, ET, MK.

Corresponding author

Correspondence to Elad Moisseiev.

Ethics declarations

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Meir Medical Center and Clalit Healthcare Organization and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

This study was approved by the Institutional Review Board of the Tel Aviv Medical Center, and all participants signed informed consent forms.

Conflict of interest

The authors declare no competing interests.

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Supplementary Information

Below is the link to the electronic supplementary material.

Movie 1: A demonstration of the “upwards” technique, using a 1-ml syringe filled with water dyed with fluorescein for visibility. (MOV 3940 KB)

Movie 2: A demonstration of the “downwards” technique, using a 1-ml syringe filled with water dyed with fluorescein for visibility. Following the same steps as in the “upwards” technique, the syringe is then turned downwards, note that the tapping causes some air bubbles to rise toward the plunger. (MOV 4874 KB)

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Krauthammer, M., Trabelsi, E. & Moisseiev, E. Intravitreal air bubbles following intravitreal injections: a comprehensive analysis. Graefes Arch Clin Exp Ophthalmol 259, 3697–3702 (2021). https://doi.org/10.1007/s00417-021-05302-0

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  • DOI: https://doi.org/10.1007/s00417-021-05302-0

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