What is the finest needle available to date for intravitreal injection?
Ocuject, LLC engineered the VitreJect needle for intravitreal injections. Several features make this a popular needle among ophthalmologists and patients. First, it is supplied in various small-caliber needle sizes. For most injections, the 33G needle is preferred by patients for improved comfort over standard 30G needles. The smaller 33G caliber reduces the rate of vitreous prolapse from the injection site following injection. Hopefully, this may reduce the risk of endophthalmitis. However, the larger caliber 30G VitreJect needle is preferred for more viscous medications such as pegcetacoplan (Syfovre).
What about persistent floaters after eye injections?
Ocuject reports 70% less silicone content in their 33G needles compared with standard 30G needles. This feature may reduce the incidence of persistent symptomatic floaters in the vision following injections.
Can we eliminate the eyelid speculum?
The VitreJect needle features a sliding shield that protects the needle from contact with the lids and lashes during the injection. This feature obviates the need for an eyelid speculum, with which many patients report discomfort. The sliding shield is secured in place by a twist-lock in order to avoid unintentional retraction of the shield and exposure of the needle.
Can we eliminate the extra caliper?
The VitreJect needle has an integrated caliper in the form of three nubs or studs that project from the end of the sliding shield that rests against the conjunctiva during injection (see image below). When the edge of one nub is placed at the limbus, the needle will insert 4mm from the limbus. When the edge of two contiguous nubs are placed at the limbus, the needle will inset 3.5mm from the limbus. A choice of three nubs are located on the shield for convenience of positioning.
What are the potential pitfalls?
If a technician opens the plastic wrapper part-way to place the needle on a syringe in preparation for injection, the twist-lock may be unintentionally unlocked. The sliding sleeve may then be accidentally retracted causing the needle to be exposed. The needle may be bent or contaminated in this situation. Technician training avoids this issue. Or, alternatively, I usually have the needle opened onto a sterile field in the exam room. I place the needle on the syringe myself.
Note: During actual injections, I wear sterile gloves.
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