-: Intravitreal ranibizumab injection
in neonates for ROP.
As supported by the BEAT ROP and RAINBOW trials,
anti-VEGF injections are used in aggressive ROP,
posterior forms of ROP,
and treatment failure with laser.
The technique of injection in neonate
is different from adult owing to smaller diameter of globe,
bigger lens volume,
and absence of pars plana.
In neonates, the injection is injected 1
to 1.25 mm posterior to the limbus
and the needle is directed towards the optic nerve.
These are the instruments which are required for injection.
Use separate sets of instruments for each eye.
A 33-week PMA baby with zone 1 aggressive ROP was planned
for intravitreal ranibizumab injection in both eyes.
The injection was given in sterile condition
under the supervision of neonatologist.
The drug is loaded into the syringe using the filter
provided by the manufacturer,
after checking the batch and the expiry of the drug.
The drug is then transferred into 31-gauge insulin syringe
with 6-mm needle,
and all the air bubbles were removed.
In insulin syringe, 1 unit is equal to 0.025 mL of drug.
The part preparation is done using povidone-iodine,
with the neonatologist holding the head
and the trunk of the baby.
Due to smaller surgical site, Tegaderm is used as a drape.
Care should be taken while applying the speculum
to avoid any lid injury.
Topical proparacaine, followed by povidone-iodine,
is instilled.
One mm mark is measured using sterile calipers.
The eye is stabilized using a lens forceps.
After marking the site of injection, the needle was injected
with orientation parallel to the optic nerve.
The needle was inserted up t0 the hub,
as it is an insulin syringe with a 6-mm needle length.
The drug is inserted slowly into the vitreous cavity,
and the needle is withdrawn slowly
and forceps are used to pinch the overline conjunctiva.
Betadine swab is kept at the injection site.
The eye is then inspected to look for any lens injury.
Separate set of instruments are used for the other eye,
and the same technique is used for the other eye as well.