The ‘ideal’ syringe for administering intravitreal injections may be available as early as next year, and there are several key factors syringe manufacturers should focus on to improve safety and efficiency, a review found.  

“Retina specialists are well aware that intravitreal injection can lead to the presence of silicone droplets in the vitreous. The droplets come from the syringes used for injection because most are manufactured with silicone oil to facilitate better gliding of the plunger. In addition, almost all needles are dipped in a silicone-oil bath to coat the outer surface to enable tissue penetration,” said Dr Gustavo Melo, researcher at the Federal University of São Paulo and head of the ophthalmology residency programme at Sergipe Eye Hospital, Brazil, presenting the review at EURETINA 2020’s virtual meeting.  

Introducing these droplets to the eye can have serious consequences. “In the 2018 American Society of Retina Specialists PAT survey, 5% of US retina specialists said they had done vitrectomy for symptomatic droplets and 2% have patients seeking legal action of their floaters. In addition, silicone droplets are linked to inflammatory reactions after aflibercept injection,” said Dr Melo. 

The ideal syringe for intravitreal injections should be silicone-oil-free, offer negligible dead space (to minimise medical waste) and feature a Luer-lock tip to allow use of the physician’s choice of attachable needle, which would also prevent leakage and accidental needle removal, said Dr Melo. 

The review included syringes commonly used in the Americas and Europe, along with emerging products from BD Luer-Lok, BD Plastipak, BD Tuberculin, BD Ultra-Fine, Braun Injekt-F, Braun Omnifix-F, West Crystal Zenith, Exel Comfort Line, HSW Norm-Ject, SJJ Zero Residual, TriboFilm StaClear, Terumo Insulin, Terumo Plajex, and SJJ Ocuject. The work drew on scientific publications and personal research. SJJ Solutions’ Ocuject syringe – expected to receive European CE certification and US Food and Drug Administration approval in mid-2021 – appeared to meet all of Dr Melo’s criteria, while The StaClear syringe (Tribofilm Research) shares similar qualities, despite the syringe being manufactured with a silicone lubricant, which is fixed to the lumen of the syringe.