A Safety Audit of Intravitreal Ranibizumab Injections by NPs
A Safety Audit of Intravitreal Ranibizumab Injections by NPs
Endophthalmitis has been reported in large cohorts of patients injected with intravitreal ranibizumab. The MARINA study reported an incidence of 0.05% per injection, while the ANCHOR study reported 0.1%. The largest UK prospective study identified 47 cases through the British Ophthalmological Surveillance Unit over a 15-month period, but the denominator figure was extrapolated to the UK population from Scottish data and an estimated incidence of 0.025% was calculated. The four cases of endophthalmitis in this study represent an incidence of 0.04% for injections given by the NPs, which is favourable relative to the rates observed in the MARINA and ANCHOR studies and similar to that reported by the British Ophthalmological Surveillance Unit. Traumatic lens damage following ranibizumab injection has been reported, but no patients treated by the NP had evidence of inadvertent lens damage on follow-up medical review.
The West of England Eye Unit of the Royal Devon and Exeter Hospital is the first NHS Foundation Trust in the UK to develop a NP-delivered intravitreal injection service and has similar rates of adverse events to that reported in other large studies undertaken by ophthalmologists. An injection service provided by a carefully selected and rigorously trained NP adhering to the necessary clinical governance safeguards has the potential to help eye units throughout the UK to meet the rising demands for wAMD treatment in an ageing population. Research has demonstrated the benefit of anti-VEGF injections for 'centre-involved' diabetic macular oedema, central retinal vein occlusion, and branch retinal vein occlusion. NICE has recently approved the use of ranibizumab for diabetic macular oedema and retinal vein occlusions, and this will result in even more pressure on the resources of NHS eye units across the UK. NP-delivered anti-VEGF injections is one solution to assist in meeting these extra demands and this method of service delivery has recently been endorsed by the Royal College of Ophthalmologists (Intra-ocular injections by non-medical health care professionals, Royal College of Ophthalmologists statement, 01/05/2013) and the Macular Society.
This large safety audit of over 10 000 injections demonstrates that carefully selected and well-trained NPs are capable of delivering a safe, effective wAMD injection treatment service, and provides a benchmark that other units can use when reviewing their own practice.
Discussion
Endophthalmitis has been reported in large cohorts of patients injected with intravitreal ranibizumab. The MARINA study reported an incidence of 0.05% per injection, while the ANCHOR study reported 0.1%. The largest UK prospective study identified 47 cases through the British Ophthalmological Surveillance Unit over a 15-month period, but the denominator figure was extrapolated to the UK population from Scottish data and an estimated incidence of 0.025% was calculated. The four cases of endophthalmitis in this study represent an incidence of 0.04% for injections given by the NPs, which is favourable relative to the rates observed in the MARINA and ANCHOR studies and similar to that reported by the British Ophthalmological Surveillance Unit. Traumatic lens damage following ranibizumab injection has been reported, but no patients treated by the NP had evidence of inadvertent lens damage on follow-up medical review.
The West of England Eye Unit of the Royal Devon and Exeter Hospital is the first NHS Foundation Trust in the UK to develop a NP-delivered intravitreal injection service and has similar rates of adverse events to that reported in other large studies undertaken by ophthalmologists. An injection service provided by a carefully selected and rigorously trained NP adhering to the necessary clinical governance safeguards has the potential to help eye units throughout the UK to meet the rising demands for wAMD treatment in an ageing population. Research has demonstrated the benefit of anti-VEGF injections for 'centre-involved' diabetic macular oedema, central retinal vein occlusion, and branch retinal vein occlusion. NICE has recently approved the use of ranibizumab for diabetic macular oedema and retinal vein occlusions, and this will result in even more pressure on the resources of NHS eye units across the UK. NP-delivered anti-VEGF injections is one solution to assist in meeting these extra demands and this method of service delivery has recently been endorsed by the Royal College of Ophthalmologists (Intra-ocular injections by non-medical health care professionals, Royal College of Ophthalmologists statement, 01/05/2013) and the Macular Society.
This large safety audit of over 10 000 injections demonstrates that carefully selected and well-trained NPs are capable of delivering a safe, effective wAMD injection treatment service, and provides a benchmark that other units can use when reviewing their own practice.