{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T20:57:21Z","timestamp":1781643441520,"version":"3.54.5"},"reference-count":18,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T00:00:00Z","timestamp":1773964800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T00:00:00Z","timestamp":1775692800000},"content-version":"vor","delay-in-days":20,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100018936","name":"Universit\u00e4tsklinikum Heidelberg","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100018936","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Int J Retin Vitr"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      New intravitreal medications can offer longer treatment duration by using higher drug concentrations, which, in turn, increase viscosity. There is also a trend toward having smaller-gauge cannulas, which require a higher injection force. While the ophthalmologist cannot control viscosity, the choice of syringe may affect the force needed to administer the drug. This study compared two standard 1-ml syringes (BD Plastipak\n                      <jats:sup>\u2122<\/jats:sup>\n                      and Braun Injekt\n                      <jats:sup>\u00ae<\/jats:sup>\n                      -F) with a syringe featuring a reduced plunger diameter (Zero Residual\n                      <jats:sup>\u2122<\/jats:sup>\n                      0\u00b72\u2009mL silicone oil-free syringe) for injecting a variety of fluids with viscosity that mimics commonly used intravitreal formulations.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Injection force over time was measured for each combination of the three syringes, four fluids, and two cannulas (30\u2009G and 33\u2009G), and the results were compared using a two-way ANOVA, followed by Tukey\u2019s post-hoc test. Plungers of the 1ml syringes had a diameter of approximately 4.70mm, while the smaller syringe had a plunger diameter of 2.48mm. Of the 1ml syringes, one was silicone oil lubricated (BD Plastipak\u2122). The tested fluids were chosen to simulate bevacizumab (Balanced Salt Solution), pegcetacoplan (13.8\u2009mg\/0.1\u2009ml of PEG-40,000), a high-viscosity solution (40\u2009mg\/0.1\u2009ml of PEG-400), and a very high-viscosity solution (Tween 80 diluted with BSS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The Zero Residual syringe required significantly lower injection forces, as quantified by both the area under the curve (AUC) and peak force. These effects became more pronounced when using smaller-diameter cannulas and increasingly viscous fluids. The BD Plastipak needed lower forces than the Braun Injekt-F.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>While silicone-oil lubrication reduced injection force, its effect was modest compared with that of plunger diameter, which was the primary determinant of the injection force required for a given viscosity and cannula diameter.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s40942-026-00833-2","type":"journal-article","created":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T09:34:23Z","timestamp":1773999263000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The effect of syringe design and cannula dimensions on time-force curve in intravitreal injection across different drug viscosities: area under the curve and peak injection force"],"prefix":"10.1186","volume":"12","author":[{"given":"Bryan Calder","family":"Ackermann","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niklas","family":"Junker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maximilian","family":"Friedrich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00d8ystein Kalsnes","family":"J\u00f8rstad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morten C.","family":"Moe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor Aristide","family":"Augustin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerd Uwe","family":"Auffarth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maximilian","family":"Hammer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,20]]},"reference":[{"key":"833_CR1","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1016\/j.preteyeres.2016.12.001","volume":"57","author":"EM Del Amo","year":"2017","unstructured":"Del Amo EM, Ak R, Heikkinen E, et al. Pharmacokinetic aspects of retinal drug delivery. Prog Retin Eye Res. 2017;57:134\u201385. https:\/\/doi.org\/10.1016\/j.preteyeres.2016.12.001.","journal-title":"Prog Retin Eye Res"},{"issue":"2","key":"833_CR2","doi-asserted-by":"publisher","first-page":"726","DOI":"10.1167\/iovs.04-0601","volume":"46","author":"J Gaudreault","year":"2005","unstructured":"Gaudreault J, Fei D, Rusit J, Suboc P, Shiu V. Preclinical pharmacokinetics of ranibizumab (rhuFabv2) after a single intravitreal administration. Investig Opthalmology Vis Sci. 2005;46(2):726. https:\/\/doi.org\/10.1167\/iovs.04-0601.","journal-title":"Investig Opthalmology Vis Sci"},{"issue":"1","key":"833_CR3","doi-asserted-by":"publisher","first-page":"2169440","DOI":"10.1080\/19420862.2023.2169440","volume":"15","author":"J Schmitt","year":"2023","unstructured":"Schmitt J, Razvi A, Grapentin C. Predictive modeling of concentration-dependent viscosity behavior of monoclonal antibody solutions using artificial neural networks. Mabs-austin. 2023;15(1):2169440. https:\/\/doi.org\/10.1080\/19420862.2023.2169440.","journal-title":"Mabs-austin"},{"key":"833_CR4","doi-asserted-by":"publisher","unstructured":"Ching J, Arai M, Ooba M, et al. Investigating the feasibility of selective anti-VEGF delivery to the retina using a microinvasive approach. Graefes Arch Clin Exp Ophthalmol. https:\/\/doi.org\/10.1007\/s00417-025-06960-0. Published online September 18, 2025.","DOI":"10.1007\/s00417-025-06960-0"},{"issue":"3","key":"833_CR5","doi-asserted-by":"publisher","first-page":"1152","DOI":"10.1002\/jps.21898","volume":"99","author":"S Yadav","year":"2010","unstructured":"Yadav S, Liu J, Shire SJ, Kalonia DS. Specific interactions in high concentration antibody solutions resulting in high viscosity. J Pharm Sci. 2010;99(3):1152\u201368. https:\/\/doi.org\/10.1002\/jps.21898.","journal-title":"J Pharm Sci"},{"issue":"10","key":"833_CR6","doi-asserted-by":"publisher","first-page":"1078","DOI":"10.1016\/j.oret.2018.05.003","volume":"2","author":"CM Aderman","year":"2018","unstructured":"Aderman CM, Rahimy E, Obeid A, et al. Comparing 33-gauge versus 30-gauge needles for intravitreal injections. Ophthalmol Retina. 2018;2(10):1078\u201379. https:\/\/doi.org\/10.1016\/j.oret.2018.05.003.","journal-title":"Ophthalmol Retina"},{"issue":"9","key":"833_CR7","doi-asserted-by":"publisher","first-page":"2812","DOI":"10.1016\/j.xphs.2020.06.003","volume":"109","author":"SS Pel\u00e1ez","year":"2020","unstructured":"Pel\u00e1ez SS, Mahler HC, Koulov A, et al. Characterization of polymeric syringes used for intravitreal injection. J Pharm Sci. 2020;109(9):2812\u201318. https:\/\/doi.org\/10.1016\/j.xphs.2020.06.003.","journal-title":"J Pharm Sci"},{"issue":"7","key":"833_CR8","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1167\/tvst.13.7.5","volume":"13","author":"M Hammer","year":"2024","unstructured":"Hammer M, Muuss M, Herbster L, et al. Viscoelastic, optical, and surgical properties of vitreous body replacement hydrogels after aging compared to porcine vitreous bodies and silicone oils. Transl Vis Sci Technol. 2024;13(7):5. https:\/\/doi.org\/10.1167\/tvst.13.7.5.","journal-title":"Transl Vis Sci Technol"},{"issue":"8","key":"833_CR9","doi-asserted-by":"publisher","first-page":"1745","DOI":"10.1016\/j.jcrs.2015.03.018","volume":"41","author":"M Usui","year":"2015","unstructured":"Usui M, Tanaka T. Resistance force for intraocular lens insertion through lens cartridges and syringe-type injectors. J Cataract Refract Surg. 2015;41(8):1745\u201351. https:\/\/doi.org\/10.1016\/j.jcrs.2015.03.018.","journal-title":"J Cataract Refract Surg"},{"issue":"6","key":"833_CR10","doi-asserted-by":"publisher","first-page":"701","DOI":"10.1097\/01.iae.0000223177.08438.2b","volume":"26","author":"KB Freund","year":"2006","unstructured":"Freund KB, Laud K, Eandi CM, Spaide RF. Silicone oil droplets following intravitreal injection. Retina. 2006;26(6):701\u201303. https:\/\/doi.org\/10.1097\/01.iae.0000223177.08438.2b.","journal-title":"Retina"},{"issue":"7","key":"833_CR11","doi-asserted-by":"publisher","first-page":"996","DOI":"10.1097\/IAE.0b013e31816c6868","volume":"28","author":"SJ Bakri","year":"2008","unstructured":"Bakri SJ, Ekdawi NS. Intravitreal silicone oil droplets after intravitreal drug injections. Retina. 2008;28(7):996\u20131001. https:\/\/doi.org\/10.1097\/IAE.0b013e31816c6868.","journal-title":"Retina"},{"issue":"12","key":"833_CR12","doi-asserted-by":"publisher","first-page":"4472","DOI":"10.1002\/jps.23297","volume":"101","author":"N Rathore","year":"2012","unstructured":"Rathore N, Pranay P, Bernacki J, Eu B, Ji W, Walls E. Characterization of protein rheology and delivery forces for combination products. J Pharm Sci. 2012;101(12):4472\u201380. https:\/\/doi.org\/10.1002\/jps.23297.","journal-title":"J Pharm Sci"},{"issue":"1","key":"833_CR13","doi-asserted-by":"publisher","first-page":"364","DOI":"10.1016\/j.xphs.2019.05.018","volume":"109","author":"C Probst","year":"2020","unstructured":"Probst C. Characterization of protein aggregates, silicone oil droplets, and protein-silicone interactions using imaging flow cytometry. J Pharm Sci. 2020;109(1):364\u201374. https:\/\/doi.org\/10.1016\/j.xphs.2019.05.018.","journal-title":"J Pharm Sci"},{"issue":"13","key":"833_CR14","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1167\/iovs.65.13.56","volume":"65","author":"S Wohlfart","year":"2024","unstructured":"Wohlfart S, Herth J, B\u00f6hmann MB, et al. Exposure to silicone oil endotamponades induces VEGF antibody aggregation and loss of functionality. Invest Ophthalmol Vis Sci. 2024;65(13):56. https:\/\/doi.org\/10.1167\/iovs.65.13.56.","journal-title":"Invest Ophthalmol Vis Sci"},{"issue":"5","key":"833_CR15","doi-asserted-by":"publisher","first-page":"288","DOI":"10.3928\/23258160-20190503-05","volume":"50","author":"GB Melo","year":"2019","unstructured":"Melo GB, Figueira ACM, Batista FAH, et al. Inflammatory reaction after aflibercept intravitreal injections associated with silicone oil droplets released from syringes: a case-control study. Ophthalmic Surg Lasers Imag Retina. 2019;50(5):288\u201394. https:\/\/doi.org\/10.3928\/23258160-20190503-05.","journal-title":"Ophthalmic Surg Lasers Imag Retina"},{"key":"833_CR16","doi-asserted-by":"publisher","first-page":"100862","DOI":"10.1016\/j.preteyeres.2020.100862","volume":"80","author":"GB Melo","year":"2021","unstructured":"Melo GB, Cruz NFSD, Emerson GG, et al. Critical analysis of techniques and materials used in devices, syringes, and needles used for intravitreal injections. Prog Retin Eye Res. 2021;80:100862. https:\/\/doi.org\/10.1016\/j.preteyeres.2020.100862.","journal-title":"Prog Retin Eye Res"},{"issue":"2","key":"833_CR17","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1038\/s41433-023-02670-1","volume":"38","author":"GB Melo","year":"2024","unstructured":"Melo GB, Santos LA, Agra LLDM, Meyer C, Moe MC, J\u00f8rstad \u00d8K. Accuracy and residual volume of intravitreal injection syringes in administration of very small volumes. Eye. 2024;38(2):395\u201396. https:\/\/doi.org\/10.1038\/s41433-023-02670-1.","journal-title":"Eye"},{"issue":"10","key":"833_CR18","doi-asserted-by":"publisher","first-page":"892","DOI":"10.1016\/j.oret.2023.06.003","volume":"7","author":"LLM Agra","year":"2023","unstructured":"Agra LLM, Sverstad A, Chagas TA, et al. Accuracy, precision, and Residual volume of commonly used syringes for intravitreal injections and the Impact on intraocular pressure. Ophthalmol Retina. 2023;7(10):892\u2013900. https:\/\/doi.org\/10.1016\/j.oret.2023.06.003.","journal-title":"Ophthalmol Retina"}],"container-title":["International Journal of Retina and Vitreous"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s40942-026-00833-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40942-026-00833-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40942-026-00833-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T20:32:54Z","timestamp":1781641974000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s40942-026-00833-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,20]]},"references-count":18,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["833"],"URL":"https:\/\/doi.org\/10.1186\/s40942-026-00833-2","relation":{},"ISSN":["2056-9920"],"issn-type":[{"value":"2056-9920","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,20]]},"assertion":[{"value":"14 December 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 March 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 March 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Bryan Calder Ackermann and Niklas Junker report that they have no competing interests. Maximilian Friedrich is funded by the Clinician Scientist Program of Heidelberg University, Faculty of Medicine. \u00d8ystein Kalsnes J\u00f8rstad reports the following: AbbVie (consultant, speaker), Bayer (consultant, speaker), Chiesi Farmaceutici (speaker), Haag-Streit (research support), Horus Pharma (consultant), Roche (consultant, funding), and SJJ Solutions (consultant, royalties, speaker). Morten Carstens Moe reports the following: Bayer (consultant), Roche (consultant, speaker), and SJJ Solutions (consultant, royalties, speaker). Victor Aristide Augustin reports the following: travel grants from Roche and grants from Kowa, outside the submitted work. Gerd Uwe Auffarth reports the following: grants, personal fees, non-financial support and consulting fees from Johnson & Johnson and Alcon, grants, personal fees, and non-financial support from Carl Zeiss Meditec, Hoya, Kowa, Teleon, Rayner, Santen, Sifi, Ursa-pharm, grants and personal fees from Biotech, Oculus, EyeYon, grants from Acufocus, Contamac, Glaukos, Physiol, Rheacell, outside the submitted work. Maximilian Hammer reports the following: a travel grant from Bayer, outside the submitted work. Maximilian Hammer is supported by the Add-On Fellowship of the Joachim Herz Foundation.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"57"}}