Safety of Superior-Temporal Intravitreal Injections using the Cotton-Tip Applicator Lid-Retraction Technique

Purpose: To demonstrate the safety of superior-temporal intravitreal injections using the cotton-tip applicator (CTA) lid-retraction technique. Methods: Retrospective chart review of superior-temporal IVT injections over a 10-year period. Results: Data from 2,227 superior temporal IVT injections were analyzed from 479 patients. The CTA method for lid retraction was utilized in 477 (99.6%) of the patients. No cases of endophthalmitis were reported and complications were limited to one vitreous hemorrhage, a single (aphakic) retinal detachment requiring repair, one patient with elevated intraocular pressure required anterior chamber paracentesis and five significant subconjunctival hemorrhages noted at the time of injection. A total of 1712 (76.2%) Bevacizumab, 484 (21.5%) aflibercept, 50 (2.2%) ranibizumab IVT injections were included. Conclusions: Superior-temporal injections with CTA guided elevation of the superior eyelid instead of a lid speculum is a safe and efficient method for IVT injection.