New Instruments REPORT OF SAFETY OF THE USE OF A SHORT 32G NEEDLE FOR INTRAVITREAL ANTI–VASCULAR ENDOTHELIAL GROWTH FACTOR INJECTIONS FOR RETINOPATHY OF PREMATURITY A Multicenter Study Linda A. Cernichiaro-Espinosa, MD* Clio A. Harper III,, MD†‡§ Sarah P. Read, MD, PHD* Lauren M. Wright, MD† Frank W. Scribbick III,, MD† Ryan Young, MD‡ Catherin I. Negron, MBA* Ana Rodríguez, RN, RRT¶ Audina M. Berrocal, MD*¶ From the *Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida; †Department of Ophthalmology, University of Texas Health Science Center, San Antonio, Texas; ‡Austin Retina Associates, Austin, Texas; §Department of Surgery and Perioperative Services, Dell Medical School, University of Texas, Austin, Texas; and ¶Neonatal Intensive Care Unit, Holtz Children’s Hospital, Jackson Health System, University of Miami, Miami, Florida. Type 1 retinopathy of prematurity (ROP) or treatment- requiring ROP was defined by the Early Treatment for ROP trial. 1 The objective of treatment of Type 1 ROP is to decrease the vascular endothelial growth factor (VEGF) response, which if untreated can lead to subse- quent retinal detachment and blindness. Intravitreal anti-VEGF treatment has become a common treatment modality. In 2011, the BEAT-ROP (Bevacizumab Eliminates the Angiogenic Threat of Retinopathy of Prematurity) study was the first controlled, randomized, multicenter clinical trial comparing intravitreal bevacizumab injec- tion to laser for the treatment of ROP. In this study, intravitreal bevacizumab was administered at a dose of 0.625 mL/0.025 mL injected by a single-use 1cc syringe with a 5/16 inch (7.93 mm) 31-gauge needle. 1 The RAINBOW study (Ranibizumab compared With Laser Therapy for the Treatment of INfants BOrn Pre- maturely With Retinopathy of Prematurity) a random- ized, controlled, prospective study will report the safety of injecting ranibizumab with a 30-g needle 1/2 inch (12.7 mm) (listed on clinicaltrials.gov NCT02375971). At the current time, no guidelines exist for intra- vitreal injection in preterm infants. It was not until February 2017 that Wright et al 2 described a technique for intravitreal injection with a small-gauge needle. At the Bascom Palmer Eye Institute (BPEI) and Austin Retina Associates (ARA), a short 32-gauge needle has also been used for intravitreal injection of anti-VEGF drugs in preterm neonates with ROP since January 2014. The overall safety of this technique merits dissemination of this information to the grow- ing international community of physicians treating ROP with intravitreal injections. Methods Data Collection This study protocol was submitted for evaluation by the Office of Research Support at the University of Texas at Austin. Office of Research Support deter- mined that the study protocol does not meet the criteria for human subjects’ research as defined in the Common Rule (45 CFR 46) or Food and Drug A. M. Berrocal is a consultant of Alcon, Inc (CA); Dorc (Dutch Ophthalmic Research Center International BV, Holland) and Visu- nex Medical Systems (CA) unrelated to this publication. The re- maining authors have no financial/conflicting interests to disclose. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.retinajournal.com). Reprint requests: Audina M. Berrocal, MD, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, 900 NW 17th Avenue, Miami, FL 33136; e-mail: aberrocal@med.miami.edu 1 Copyright ª by Ophthalmic Communications Society, Inc. Unauthorized reproduction of this article is prohibited.