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October 2004

Rinsing of the Cannula Prior to IntravitrealInjection—Reply

Arch Ophthalmol. 2004;122(10):1572. doi:10.1001/archopht.122.10.1572-a

In reply

I thank Drs Degenring and Jonas for their thoughtful comments on ourstudy of a single injection of intravitreal triamcinolone acetonide for exudativeage-related macular degeneration, any part of which was classic. Althoughit is true that we might have found an effect of the drug on the primary outcome(loss of 30 logMAR letters) if we had treated the patients every 4 to 6 months,we were as surprised as everyone else when we did not find a beneficial effecton severe or moderate (15 letters) vision loss even at the 3- or 6-month timepoints. Whatever the reason for this might be (apart from the possibilitythat it is simply not particularly efficacious for classic subretinal neovascularization),incorrect preparation of the injection is not it. We can confirm that theinjections were performed using a standardized technique by an experiencedretinal fellow. This entailed drawing up at least 0.2 mL of the drug aftershaking the ampoule, then expressing air and the drug to leave 0.15 mL ofthe drug in the syringe before attaching a 27-gauge needle. The plunger wasadvanced until the 0.05-mL dead space was eliminated, after which a full 0.1mL was injected into the vitreous. In our article, we compared the outcomesof treated eyes that exhibited an intraocular pressure response, which werethus marked as having received a significant dose of steroid, with those thatdid not, and we found no difference.