{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:21:28Z","timestamp":1792790488231,"version":"4.5.0"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T00:00:00Z","timestamp":1761177600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The objective of this study was to assess the safety and efficacy of simultaneous bilateral intravitreal injections of anti-vascular endothelial growth factors (anti-VEGF) from a single vial for the treatment of diabetic macular edema (DME).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A retrospective case series study was undertaken. The study population comprised patients who underwent intravitreal anti-vascular endothelial growth factor injections for DME at the Ophthalmology department of Zhejiang Hospital between January 2022 and May 2024. Participants were categorized into bilateral (\n                      <jats:italic>n<\/jats:italic>\n                      = 34, 102 injections) and unilateral (\n                      <jats:italic>n<\/jats:italic>\n                      = 93, 210 injections) groups. The primary outcome measures were best corrected visual acuity (BCVA) and central subfield thickness (CST), cube average thickness (CAT) along with the incidence of severe clinical complications. Statistical analysis was performed using the Mann-Whitney U test and Wilcoxon rank sum test.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      There were no statistically significant differences in terms of age, gender, hypertension, years of diabetes, disorganization of the inner retinal layers (DRIL), ellipsoid zone (EZ) grade, BCVA, CST or CAT at baseline between the two groups. Both bilateral and unilateral injection groups demonstrated significant enhancements in BCVA at 1 month post-injection (\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001;\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001). A substantial decrease in CST and CAT were observed in both groups at 1 month post-injection (\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001;\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001;\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.000;\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.000). The median improvement in BCVA at 1 month post-injection relative to pre-injection was 8.0 letters (IQR: 3.0\u201319.0) in the bilateral injection group and 5.5 letters (IQR: 1.0\u201313.0) in the unilateral injection group, with a statistically significant difference between the two groups (\n                      <jats:italic>P<\/jats:italic>\n                      = 0.009). The reduction in CAT demonstrated significant difference between the two groups (\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001). No severe complications, including cataract, retinal detachment, choroidal detachment, vitreous hemorrhage, or endophthalmitis, were reported in any of the patients.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Simultaneous bilateral anti-VEGF injections from a single vial are both safe and efficacious for the treatment of DME, thereby reducing the treatment burden, visit times and costs while enhancing patient compliance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2025.1712378","type":"journal-article","created":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T05:35:47Z","timestamp":1761197747000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Simultaneous bilateral intravitreal anti-vascular endothelial growth factor injections from one vial for diabetic macular edema: a retrospective analysis"],"prefix":"10.3389","volume":"12","author":[{"given":"Yuanmin","family":"Dai","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jixian","family":"Lou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiquan","family":"Wen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guanlu","family":"Liang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiehui","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiguo","family":"Jing","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juanjuan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,23]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1016\/j.preteyeres.2015.06.002","article-title":"Molecular pathogenesis of retinal and choroidal vascular diseases.","volume":"49","author":"Campochiaro","year":"2015","journal-title":"Prog Retin Eye Res."},{"key":"B2","doi-asserted-by":"publisher","first-page":"1193","DOI":"10.1056\/NEJMoa1414264","article-title":"Aflibercept, bevacizumab, or ranibizumab for diabetic macular edema.","volume":"372","author":"Wells","year":"2015","journal-title":"N Engl J Med."},{"key":"B3","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1186\/s40942-015-0010-y","article-title":"Endophthalmitis following intravitreal anti-vascular endothelial growth factor (VEGF) injection: a comprehensive review.","volume":"1","author":"Merani","year":"2015","journal-title":"Int J Retina Vitreous."},{"key":"B4","doi-asserted-by":"publisher","first-page":"667","DOI":"10.1016\/j.ophtha.2017.01.001","article-title":"Trends in vitreoretinal procedures for medicare beneficiaries, 2000 to 2014.","volume":"124","author":"McLaughlin","year":"2017","journal-title":"Ophthalmology."},{"key":"B5","doi-asserted-by":"publisher","first-page":"708","DOI":"10.1016\/j.ophtha.2023.12.026","article-title":"faricimab treat-and-extend for diabetic macular edema: two-year results from the randomized phase 3 YOSEMITE and RHINE trials.","volume":"131","author":"Wong","year":"2024","journal-title":"Ophthalmology."},{"key":"B6","first-page":"84","article-title":"Afarcept in visual impairment due to diabetic macular edema: VIVID-EAST study 1-year results.","volume":"65","author":"Rishi","year":"2022","journal-title":"Ophthalm Res."},{"key":"B7","first-page":"1344","article-title":"Cerebrovascular accidents in patients treated for diabetic macular edema with ranibizumab in the RIDE and RISE trials.","volume":"125","author":"Bressler","year":"2018","journal-title":"Ophthalmology."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1185","DOI":"10.1136\/bjophthalmol-2016-309729","article-title":"Five-year progression of unilateral age-related macular degeneration to bilateral involvement: the three continent AMD consortium report.","volume":"101","author":"Joachim","year":"2017","journal-title":"Br J Ophthalmol."},{"key":"B9","doi-asserted-by":"publisher","first-page":"556","DOI":"10.2337\/dc11-1909","article-title":"Global prevalence and major risk factors of diabetic retinopathy.","volume":"35","author":"Yau","year":"2012","journal-title":"Diabetes Care."},{"key":"B10","doi-asserted-by":"publisher","first-page":"2874","DOI":"10.1038\/s41433-024-03185-z","article-title":"Greener intravitreal injections: a narrative review.","volume":"38","author":"Ong","year":"2024","journal-title":"Eye."},{"key":"B11","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1016\/j.ajo.2009.02.013","article-title":"Bilateral simultaneous intravitreal injections in the office setting.","volume":"148","author":"Bakri","year":"2009","journal-title":"Am J Ophthalmol."},{"key":"B12","doi-asserted-by":"publisher","first-page":"1213","DOI":"10.1097\/IAE.0b013e3181b32d27","article-title":"Evaluation of safety for bilateral same-day intravitreal injections of antivascular endothelial growth factor therapy.","volume":"29","author":"Lima","year":"2009","journal-title":"Retina."},{"key":"B13","first-page":"247","article-title":"Patient Preference and Safety of Bilateral Intravitreal Injection of Anti-VEGF Therapy.","volume":"50","author":"Galler","year":"2009","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"B14","doi-asserted-by":"publisher","first-page":"550","DOI":"10.1016\/j.jdiacomp.2019.05.006","article-title":"Disorganization of retinal inner layers correlates with ellipsoid zone disruption and retinal nerve fiber layer thinning in diabetic retinopathy.","volume":"33","author":"Gauhar","year":"2019","journal-title":"J Diabetes Compl."},{"key":"B15","doi-asserted-by":"publisher","first-page":"1309","DOI":"10.1001\/jamaophthalmol.2014.2350","article-title":"Disorganization of the retinal inner layers as a predictor of visual acuity in eyes with center-involved diabetic macular edema.","volume":"132","author":"Sun","year":"2014","journal-title":"JAMA Ophthalmol."},{"key":"B16","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1186\/s12886-016-0317-y","article-title":"Estimation of the need for bilateral intravitreal anti-VEGF injections in clinical practice.","volume":"16","author":"Audrey","year":"2016","journal-title":"BMC Ophthalmol."},{"key":"B17","doi-asserted-by":"publisher","first-page":"87","DOI":"10.4103\/0974-9233.106402","article-title":"Acute bilateral endophthalmitis following bilateral intravitreal bevacizumab (avastin) injection.","volume":"20","author":"Tabatabaii","year":"2013","journal-title":"Middle East Afr J Ophthalmol."},{"key":"B18","doi-asserted-by":"publisher","first-page":"3211","DOI":"10.2147\/OPTH.S276620","article-title":"Evaluation of the safety of bilateral same-day intravitreal injections of anti-vascular endothelial growth factor agents: experience of a large korean retina center.","volume":"14","author":"Kyuhwan","year":"2020","journal-title":"Clin Ophthalmol."},{"key":"B19","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1097\/IAE.0b013e3181ed8c80","article-title":"Bilateral intravitreal injection of antivascular endothelial growth factor therapy.","volume":"31","author":"Mahajan","year":"2011","journal-title":"Retina."},{"key":"B20","doi-asserted-by":"publisher","first-page":"2055","DOI":"10.1007\/s40123-025-01184-1","article-title":"Safety evaluation of bilateral same-day intravitreal injection of faricimab.","volume":"14","author":"Karampelas","year":"2025","journal-title":"Ophthalmol Ther."},{"key":"B21","first-page":"835","article-title":"Visual outcome of bilateral same-session intravitreal anti-VEGF injections.","volume":"59","author":"Bagheri","year":"2018","journal-title":"Invest Ophthalmol Vis Sci."},{"key":"B22","doi-asserted-by":"publisher","first-page":"e102","DOI":"10.3928\/23258160-20180907-16","article-title":"Fellow eye anti-VEGF \u2018crunch\u2019 effect in retinopathy of prematurity.","volume":"49","author":"Wood","year":"2018","journal-title":"Ophthalm Surg Lasers Imaging Retina."},{"key":"B23","doi-asserted-by":"crossref","first-page":"5883","DOI":"10.21608\/ejhm.2019.64850","article-title":"Effect of monocular intravitreal anti-vascular endothelial growth factor injection on the fellow eye.","volume":"77","author":"Abd El-Moniem","year":"2019","journal-title":"Egypt J Hosp Med."},{"key":"B24","doi-asserted-by":"publisher","first-page":"32","DOI":"10.3341\/kjo.2014.28.1.32","article-title":"Serum concentration of vascular endothelial growth factor after bilateral intravitreal injection of bevacizumab.","volume":"28","author":"Donghyun","year":"2014","journal-title":"Korean J Ophthalmol."},{"key":"B25","doi-asserted-by":"publisher","first-page":"299","DOI":"10.2147\/OPTH.S124282","article-title":"Safety of bilateral same-day intravitreal injections of anti-vascular endothelial growth factor agents.","volume":"11","author":"Ru\u00e3o","year":"2017","journal-title":"Clin Ophthalmol."},{"key":"B26","doi-asserted-by":"publisher","first-page":"2341","DOI":"10.1097\/IAE.0000000000001488","article-title":"Low endophthalmitis rates after intravitreal anti-vascular endothelial growth factor injections in an operation room: a retrospective multicenter study.","volume":"37","author":"Freiberg","year":"2017","journal-title":"Retina."},{"key":"B27","doi-asserted-by":"publisher","first-page":"544","DOI":"10.4103\/1119-3077.183313","article-title":"Bilateral concomitant intravitreal anti-vascular endothelial growth factor injection: experience in a Nigerian tertiary private eye care facility.","volume":"19","author":"Okoye","year":"2016","journal-title":"Niger J Clin Pract."},{"key":"B28","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1159\/000499115","article-title":"Same-day bilateral intravitreal anti-vascular endothelial growth factor injections: experience of a large canadian retina center.","volume":"242","author":"Juncal","year":"2019","journal-title":"Ophthalmologica."},{"key":"B29","doi-asserted-by":"publisher","first-page":"3211","DOI":"10.2147\/OPTH.S276620","article-title":"Evaluation of the safety of bilateral same-day intravitreal injections of anti-vascular endothelial growth factor agents: experience of a large korean retina center.","volume":"14","author":"Jang","year":"2020","journal-title":"Clin Ophthalmol."},{"key":"B30","doi-asserted-by":"publisher","first-page":"2324","DOI":"10.12669\/pjms.38.8.5125","article-title":"Safety of simultaneous bilateral intravitreal versus unilateral anti-vasculo-endothelial growth factors injection in an operating room setting.","volume":"38","author":"Jeeva","year":"2022","journal-title":"Pak J Med Sci."},{"key":"B31","doi-asserted-by":"publisher","first-page":"703","DOI":"10.2147\/opth.s10008","article-title":"Concomitant bilateral intravitreal anti-VEGF injections for the treatment of exudative age-related macular degeneration.","volume":"4","author":"Davis","year":"2010","journal-title":"Clin Ophthalmol."},{"key":"B32","doi-asserted-by":"publisher","first-page":"e491","DOI":"10.1111\/j.1755-3768.2011.02327.x","article-title":"Same-day consecutive bilateral intravitreal injections of ranibizumab for the treatment of bilateral active choroidal neovascularization in age-related macular degeneration.","volume":"90","author":"Shah","year":"2012","journal-title":"Acta Ophthalmol."},{"key":"B33","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.ajo.2018.06.022","article-title":"Endophthalmitis rates after bilateral same-day intravitreal anti-vascular endothelial growth factor injections.","volume":"194","author":"Borkar","year":"2018","journal-title":"Am J Ophthalmol."},{"key":"B34","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1159\/000486145","article-title":"2018 update on intravitreal injections: euretina expert consensus recommendations.","volume":"239","author":"Grzybowski","year":"2018","journal-title":"Ophthalmologica."},{"key":"B35","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1016\/j.ajo.2018.08.030","article-title":"Endophthalmitis rates after bilateral same-day intravitreal anti-vascular endothelial growth factor injections.","volume":"196","author":"Grzybowski","year":"2018","journal-title":"Am J Ophthalmol."},{"key":"B36","doi-asserted-by":"publisher","first-page":"667","DOI":"10.1097\/IAE.0b013e31822c296b","article-title":"Bilateral same-day intravitreal injections using a single vial and molecular bacterial screening for safety surveillance.","volume":"32","author":"Se","year":"2012","journal-title":"Retina."},{"key":"B37","doi-asserted-by":"publisher","first-page":"143","DOI":"10.3928\/23258160-20140306-08","article-title":"Meta-analysis of infectious endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor agents.","volume":"45","author":"Fileta","year":"2014","journal-title":"Ophthalm Surg Lasers Imaging Retina."},{"key":"B38","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1097\/IAE.0b013e318203c0ef","article-title":"Systemic safety of bilateral intravitreal anti-vascular endothelial growth factor injections.","volume":"31","author":"Freund","year":"2011","journal-title":"Retina."},{"key":"B39","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1007\/s10792-024-02983-4","article-title":"Endophthalmitis following same-day bilateral anti-VEGF injections: a systematic review.","volume":"44","author":"Bjerager","year":"2024","journal-title":"Int Ophthalmol."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1712378\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T05:35:48Z","timestamp":1761197748000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1712378\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,23]]},"references-count":39,"alternative-id":["10.3389\/fmed.2025.1712378"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1712378","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,23]]},"article-number":"1712378"}}