Safe Administration of Multiple Doses from a Single Vial of Intravitreal Anti-VEGF Lucentis

Background: Anti-VEGF, Intravitreal ranibizumab (Lucentis) has revolutionised the treatment of retinal vascular diseases. However, the high cost remains a significant barrier in resource-limited settings. This study evaluates the safety of administering three intravitreal injections from a single Lucentis vial under strict aseptic conditions. Objective: To determine the safety of using a single vial of Lucentis for multiple intravitreal injections regarding endophthalmitis and other post-injection complications. Methods: A retrospective cohort study was conducted at Alehsan Eye Hospital from January to December 2024. Data from 200 patients with diabetic macular edema (DME) or neovascular age-related macular degeneration (nAMD) were reviewed. Each vial of Lucentis was used for three consecutive injections following a standardised aseptic protocol. Data were collected through retrospective chart review and analysed using descriptive statistics. Results: No cases of post-injection endophthalmitis were recorded. Minor adverse events included floaters (18%), redness (6%), eye pain (7%), and mild intraocular pressure rise (2%). Intraocular inflammation occurred in 1% of cases. Visual acuity remained stable or improved in most patients. Conclusion: According to this study, administering multiple doses of Lucentis from a single vial was found to be safe, with no incidence of postoperative endophthalmitis and a low rate of complications. This approach may serve as a practical alternative to traditional procedures, particularly in resource-limited settings. Future studies with larger cohorts are warranted to further validate the safety and long-term outcomes of this strategy.