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Abstract

Purpose: To study the incidence of iatrogenic crystalline lens injury in a medical officer-led intravitreal (IVT) injection clinic and to evaluate the effect of a structured training programme designed to teach medical officers how to safely administer IVT injections.

Study design: Clinical audit.

Methods: The first phase of the clinical audit comprised a retrospective analysis of the consecutive numbers of IVT injections between January and December 2020. Outcome measures included incidence and risk factors of lens injury. Target incidence rate of iatrogenic crystalline lens injury was set at < 0.06%. Intervention was implemented in the form of a structured training programme over the course of 4 months. The programme encompassed a lecture and video on proper administration techniques, as well as a handout detailing the key points. Medical officers were guided, directly supervised, and assessed by a single ophthalmologist and were required to complete a logbook before being sanctioned to perform IVT independently. Re-audit was done on the consecutive numbers of IVT injections in the following year, between May 2021 and April 2022.

Results: Out of 1,952 IVT injections performed by medical officers pre-intervention, 3 cases of iatrogenic lens injuries were reported, corresponding to an incidence rate of 0.15%. One patient was uncooperative. No other risk factors were identified. Post-intervention, our target was achieved with zero injection-related lens injury out of 2,118 consecutive IVT injections.

Conclusion: A structured training programme results in highly skilled medical officers delivering a well-rounded service that improves the quality of care and reduces the rate of adverse events in a large overburdened tertiary centre. Training must be conducted on a regular basis due to the entry of new medical officers periodically.