Use of a desmarres retractor for upper lid and lash isolation during intravitreal injections

摘要

The injection of substances into the vitreous cavity has become one of the most common procedures in the United States.Although rare, endophthalmitis is the most visually devastating complication. Multiple maneuvers have been suggested and implemented to decrease its incidence. One of the most common is the use of a bladed lid speculum to isolate the patient's lids and lashes from the needle and injection site. Reviewing the VISION study, Gragoudas et al attributed many of the infections in the VISION study to not using a lid speculum. A survey in 2010 reported that 92% of retinal surgeons use specula with their intravitreal injections. Unfortunately, the insertion of the speculum is regarded as one of the most uncomfortable portions of the procedure and leaves the ocular surface unprotected by the eyelids while the speculum is in place. Intuitively, this exposure could create discomfort from dryness and epithelial breakdown after injection.