Bimanual Assisted Eyelid Retraction Technique for Intravitreal Injections

In Brief Purpose: To describe an alternative technique for avoiding contact with the lids and eyelashes without the use of a metal lid speculum along with the results in clinical practice. Methods: Retrospective review of the medical records of all patients undergoing intravitreal injections of bevacizumab and ranibizumab with lid retraction achieved by bimanual assisted eyelid retraction between November 2010 and December 2011. Results: A total of 10,164 consecutive intravitreal injections were performed, of which 3,834 were bevacizumab and 6,330 were ranibizumab. In this cohort of patients, 3 suspected cases of endophthalmitis developed (2 culture-negative), corresponding to a rate of 0.03%. Conclusion: The technique of bimanual assisted eyelid retraction for intravitreal injection has a low rate of infection similar to the reported rates using a metal lid speculum. This article presents an alternative technique to the use of a metal lid speculum during intravitreal injection procedures. Using bimanual assisted eyelid retraction in over 10,000 consecutive injections, the authors noted an endophthalmitis rate similar to those reported using a metal lid speculum.