Intravitreal anti-vascular endothelial growth factor injection for retinopathy of prematurity

Background: Intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections have emerged as the first-line treatment for severe retinopathy of prematurity (ROP) in zone 1 and aggressive ROP. [1,2] The technique of intravitreal injection in infants is different from adults. An inappropriate site or direction of the needle can injure the lens or retina. [3,4] Purpose: This video demonstrates a safe and reproducible technique of anti-VEGF injection in infants with ROP in the ophthalmic operation theater (OT) or neonatal intensive care unit (NICU). Synopsis: Written informed consent must be obtained before the procedure. The pupils are dilated preoperatively, and the procedure can be performed under topical anesthesia. Perioperative 5% povidone iodine eyedrops must be used with an adequate holding period. [4,5] Under aseptic measures, using an operating microscope or surgical loupe, the needle is introduced at the site between 1 mm and 1.5 mm from the limbus, with the direction being parallel to the visual axis. [5] The vitals of the infant should be monitored during the entire procedure. The first postoperative examination shall be planned within a week to look for procedure-related complications. [4,5] Highlights: The procedure can be done bilaterally, on the same day, in the OT or the NICU, safely. Use of perioperative 5% Povidone Iodine eyedrops is essential. The surgeon shall pay due attention to the site and direction of the needle to avoid lens and retinal injury. Postoperative examination, planned within the first week, should be done to look for injection-related complications. Video link: https://youtu.be/lxyasOWyV3I