Intravitreal Anti-vascular Endothelial Growth Factor Injection Practices Among Indonesian Vitreoretinal Specialists: Findings From a 2021 National Survey

Objective: This study aims to describe the preferred methods for performing intravitreal anti-vascular endothelial growth factor (VEGF) injections among vitreoretinal specialists in Indonesia, including preinjection assessment, bevacizumab preparation, aseptic measures, injection technique, and post-injection care.Methods: This was a descriptive survey of self-reported practice patterns.A cross-sectional survey was carried out, where active members of the Indonesian Vitreoretinal Society (INAVRS) were asked to complete a 44-item online survey on their intravitreal injection (IVI) technique.The survey was conducted in 2021.Results: Out of the 116 participating vitreoretinal specialists, the response rate was 82.8%.Bevacizumab was the most commonly used anti-VEGF (73.3%).Around half of the participants (53.4%) assessed systemic and cardiac risks.A large portion (74.1%) did not use prophylactic topical antibiotics.Most injections (92.2%) were performed in a main operating room with the patient lying on their back (96.5%) and using tetracaine eye drops (94%).A majority (78.4%) avoided performing bilateral injections on the same day.Around 60.9% utilized a single puncture method for bevacizumab preparation, and 57.3% stored the opened bevacizumab vial for less than a week (27.5%) to up to a month (24.6%).During the COVID-19 pandemic, 100% of surgeons, assistants, and patients wore masks.Sterile gloves, a lid speculum, and a sterile ophthalmic drape were used by all participants, and 98.3% utilized povidone-iodine for antisepsis.A caliper was used by 69.8% of participants to measure the injection site, and a 30G needle was used in 94.8% of cases, mostly in the superotemporal quadrant (70.7%).Visual acuity post-injection was assessed with a counting finger test by 34.5%, while 95.7% of participants prescribed post-injection antibiotic drops for several days.Conclusion: Substantial variability was observed in self-reported intravitreal anti-VEGF injection practices, with some divergence from evidence-based recommendations.These findings reflect historical practice patterns and should not be interpreted as evidence of the comparative safety or effectiveness of specific procedural techniques.