Safety of nurse-led intravitreal injection of dexamethasone (Ozurdex) implant service. Audit of first 1000 cases

Abstract

Purpose: To assess the safety of nurse-led services of intravitreal injection of dexamethasone implant. Methods: An audit of intravitreal injection of dexamethasone implant service in our unit revealed a significant delay in the delivery of injection from the time a clinical decision was made. The limiting factors were an inadequate number of injectors and limited capacity. The constraint in capacity was addressed by moving the service from the theatre to the cleanroom in the outpatients setting. Two senior nurse practitioners in the existing pool of injectors, experienced in intravitreal anti-VEGF injection, were trained to deliver the intravitreal dexamethasone implant service. A safety audit was carried out after they had completed 1000 cases. Results: The nurse practitioners administered 1006 injections from February 2017 to October 2019. There was no case of endophthalmitis (0%) or other visually significant complications like retinal detachment, vitreous haemorrhage, hypotony or iatrogenic cataract. One patient had incomplete scleral penetration of the implant, but this resolved without any sequelae. The waiting time to inject the implant nearly halved from 29.5 to 15 days in the nurse-led service. A patient satisfaction survey was overwhelmingly positive, with the majority advocating for the continuation of the nurse-led service. Conclusion: The current cohort of experienced nurses providing anti-VEGF injections can be trained under supervision to inject the intravitreal dexamethasone implant (Ozurdex). This is safe, additionally effective in streamlining the service and reducing the waiting time for delivery of the steroid implant.