Prefilled syringes for intravitreal drug delivery

Abstract

Intravitreal injections of anti-vascular endothelial growth factor (VEGF) medications play an increasingly critical role in numerous retinal vascular diseases. Initially, anti-VEGF medications came in vials that had to be drawn up by the physician into a syringe for administration. In 2018, the US Food and Drug Administration (US FDA) approved the ranibizumab 0.3 mg prefilled syringe (PFS), and in October 2016, the US FDA approved the ranibizumab 0.5 mg PFS. This article discusses the advantages of the PFS, including reduced injection time, possible reduced risk of endophthalmitis, reduction in intraocular air bubbles and silicone oil droplets, and improved precision in the volume and dose of intravitreal ranibizumab administered, along with possible disadvantages. Implications of the innovation of the PFS on intravitreal injection technique and clinical practice pattern are discussed and reviewed.

Keywords: anti-VEGF; diabetic retinopathy; intravitreal injection; intravitreous injection; prefilled syringe; ranibizumab.

Figure 1

Photograph of ranibizumab PFS. Abbreviation: PFS, prefilled syringe.

Figure 2

Endophthalmitis: 66-year-old male with aggressive endophthalmitis resulting in enucleation. (A) External photograph demonstrating conjunctival injection and hypopyon. (B) Slit-beam photo demonstrating hypopyon and keratic precipitates.

Figure 3

Silicone oil droplets post intravitreal injection of bevacizumab: 78-year-old female with exudative age-related macular degeneration of the right eye who had been receiving intravitreal injections of Avastin (bevacizumab) every 1–2 months for 4 years and 3 months demonstrating silicone oil droplets. Visual acuity was 20/60 on the initiation of anti-VEGF therapy and 20/25 at last follow-up on the acquisition of the photograph. Abbreviation: VEGF, vascular endothelial growth factor.