Topical anesthetic pledgett system (TAPS) for intravitreal injection preparation.

UNLABELLED: There are many methods of preparing a patient for intravitreal injection. The method described here allows for highly effective and reproducible topical anesthetic delivery, resulting in excellent patient comfort, as well as offering a "hands-free" topical anesthetic delivery system, resulting in more efficient time management for staff.

PURPOSE: Pledgett drug delivery is nothing new to ophthalmology. This technique has been proven to be effective when used to deliver dilating drugs. The goal of this method design is to provide a topical anesthetic delivery method that is effective, both in anesthetic coverage and to increase patient flow and staff productivity.

METHODS

A small portion of cotton (approx. 1 cm x 2 cm) is taken from the inside of an eye patch. This is then soaked in 4% Lidocaine and rolled into a tubular pledgett, resulting in a width of approx. 5 mm (see image 1). The pledgett is then placed in the inferior fornix, which is exposed by pulling down the lower lid. A scleral depressor (Storz-USA E-5108) is used to position the pledgett so that the site of injection is completely covered (see image 2). Patients are directed to close their eyes and are then left in a reclined position. This increases comfort and reduces the tendency for the eye to rotate inferiorly, therefore reducing the risk of corneal abrasion. The pledgett is left in place for approximately 5-7 minutes, then removed and the prep completed.

RESULTS

In an informal study of responses, patients reported no discomfort with placement of the pledgett, and minimal discomfort during injection. Staff productivity increased with the allowance of the staff to either prepare the injection or to place pledgetts in multiple patients simultaneously.

CONCLUSIONS

The topical anesthetic pledgett (TAP) delivery system is an effective tool in the intravitreal injection practice. With patient injections increasing exponentially, this system will allow for better anesthetic coverage and more efficient patient flow.