Effect of injection site on severity of pain in intravitreal injection of bevacizumab ABSTRACT
Purpose: To evaluate the relationship between the site of injection and the severity of pain in patients receiving intravitreal bevacizumab (IVB).
Methods: In this interventional prospective clinical trial 1004 eyes of 1004 patients who were candidates to received IVB were randomized into 4 groups: superotemporal, superonasal, inferotemporal, and inferonasal site for injection.
Visual Analog Scale (VAS) was used to indicate the severity of pain and also the relationship between severity of pain and injection site, number of previous injections besides age, sex, indication for injection, best corrected visual acuity (BCVA) as well as central macular …show more content…
Intravitreal injections are performed successfully for the treatment of a wide variety of ocular disease including neovascular age-related macular degeneration (AMD), diabetic macular edema (DME), and retinal vascular occlusions (RVO) [2-7]. Bevacizumab and ranibizumab , a fragment of a humanized monoclonal antibody, are the most common used anti-VEGF agents. [8-9]. In the United States, it has been estimated that over 100,000 intravitreal injections are performed monthly. This procedure might become the most common intraocular procedure worldwide [10]. However, the best site for intravitreal injection is not clear and the correlation between injection site and severity of pain is not well understood. Patient distress at the time of injection results in sudden actions of the eye, associated with intraocular complications [11] and the patients after this unpleasant experience are less likely to continue intravitreal injection [12]. Therefore, minimizing patient pain is critical during intravitreal injection because many patients require multiple intravitreal injections, and the pain associated with the procedure may affect their comfort and …show more content…
So far, only few small studies investigated the pain associated with injection [13]. Most studies compared the anesthetic methods preceding the injection, however, none of them have reported a statistically significant difference in overall pain reported by the patients [14-18]. Tunneled injection has been shown to decrease vitreous reflux and loss of injected drug, but no difference in patient pain has been found between tunneled and straight intravitreal injections [19,20]. Moreover, it has also been indicated that smaller gauge needles (29–30 G) are associated with reduced pain (26–27 G) [19].
Several guidelines have been released to standardize the procedure, especially in order to reduce the risk of endophthalmitis. [21-23] However, despite the common use of intravitreal injections, there are no uniform clinical guidelines or consensus on the site or the quadrant location that used for injection [11-21] and it varies in each case according to the surgeons discretion. The aim of this study was to investigate the effect of injection site on the pain severity in patients receiving intravitreal bevacizumab
Purpose: To evaluate the relationship between the site of injection and the severity of pain in patients receiving intravitreal bevacizumab (IVB).
Methods: In this interventional prospective clinical trial 1004 eyes of 1004 patients who were candidates to received IVB were randomized into 4 groups: superotemporal, superonasal, inferotemporal, and inferonasal site for injection.
Visual Analog Scale (VAS) was used to indicate the severity of pain and also the relationship between severity of pain and injection site, number of previous injections besides age, sex, indication for injection, best corrected visual acuity (BCVA) as well as central macular …show more content…
Intravitreal injections are performed successfully for the treatment of a wide variety of ocular disease including neovascular age-related macular degeneration (AMD), diabetic macular edema (DME), and retinal vascular occlusions (RVO) [2-7]. Bevacizumab and ranibizumab , a fragment of a humanized monoclonal antibody, are the most common used anti-VEGF agents. [8-9]. In the United States, it has been estimated that over 100,000 intravitreal injections are performed monthly. This procedure might become the most common intraocular procedure worldwide [10]. However, the best site for intravitreal injection is not clear and the correlation between injection site and severity of pain is not well understood. Patient distress at the time of injection results in sudden actions of the eye, associated with intraocular complications [11] and the patients after this unpleasant experience are less likely to continue intravitreal injection [12]. Therefore, minimizing patient pain is critical during intravitreal injection because many patients require multiple intravitreal injections, and the pain associated with the procedure may affect their comfort and …show more content…
So far, only few small studies investigated the pain associated with injection [13]. Most studies compared the anesthetic methods preceding the injection, however, none of them have reported a statistically significant difference in overall pain reported by the patients [14-18]. Tunneled injection has been shown to decrease vitreous reflux and loss of injected drug, but no difference in patient pain has been found between tunneled and straight intravitreal injections [19,20]. Moreover, it has also been indicated that smaller gauge needles (29–30 G) are associated with reduced pain (26–27 G) [19].
Several guidelines have been released to standardize the procedure, especially in order to reduce the risk of endophthalmitis. [21-23] However, despite the common use of intravitreal injections, there are no uniform clinical guidelines or consensus on the site or the quadrant location that used for injection [11-21] and it varies in each case according to the surgeons discretion. The aim of this study was to investigate the effect of injection site on the pain severity in patients receiving intravitreal bevacizumab