Nailing intravitreal implant injections
Experienced user details proper handling, injection technique of FAc implant for DME
Removing the cap
Compared with Ozurdex, the cap covering the Iluvien needle is smaller, smooth, lacks a collar, and can be hard to grip. In about 20% of cases, the cap is difficult to remove, perhaps due to excessive amount of adhesive used to secure the cap to the applicator.
Rather than trying to pull it straight out, I now twist it clockwise and counter clockwise until the seal breaks.
The process of hollowing out the 25-gauge needle slightly blunts it and makes it more delicate. Therefore, straight or near-straight entry is preferable to markedly angled entry as commonly used for Ozurdex. Due to smaller gauge of the Iluvien needle compared with that of Ozurdex, there is less likelihood of wound leak and therefore less need for an angled approach.
The FAc implant is released into the vitreous cavity by advancing the button all the way. After the needle has been inserted and its position verified, press at the back end of the actuator button with your index finger and steadily advance it in its guide rail as far as it goes to release the implant. Usually an audible click is heard as the back of the actuator button is depressed. After the button has been advanced all the way, rotate the device slightly clockwise and counterclockwise to let the implant disengage from the needle. Unlike Ozurdex’s spring-loaded mechanism to shoot the implant into the vitreous cavity, the FAc implant may “hang” at the needle tip and must be allowed to release before the needle is withdrawn.
The needle is withdrawn and its track covered by the sterile cotton-tipped applicator to prevent wound leak. A drop of Betadine is instilled and the lid speculum is removed. Check to ensure the patient has formed vision.