April 2014
Volume 55, Issue 13
Free
ARVO Annual Meeting Abstract  |   April 2014
Are intravitreal injections with ultrathin 33G needles less painful?
Author Affiliations & Notes
  • Freekje van Asten
    Department of Ophthalmology, Radboud UMC, Nijmegen, Netherlands
  • Henriët van Middendorp
    Department of Medical Psychology, Radboud UMC, Nijmegen, Netherlands
  • Samuël Verkerk
    Department of Ophthalmology, Radboud UMC, Nijmegen, Netherlands
  • Myrte Breukink
    Department of Ophthalmology, Radboud UMC, Nijmegen, Netherlands
  • Carel C B Hoyng
    Department of Ophthalmology, Radboud UMC, Nijmegen, Netherlands
  • Andrea W Evers
    Department of Medical Psychology, Radboud UMC, Nijmegen, Netherlands
  • B Jeroen Klevering
    Department of Ophthalmology, Radboud UMC, Nijmegen, Netherlands
  • Footnotes
    Commercial Relationships Freekje van Asten, None; Henriët van Middendorp, None; Samuël Verkerk, None; Myrte Breukink, None; Carel Hoyng, None; Andrea Evers, None; B Klevering, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science April 2014, Vol.55, 581. doi:
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      Freekje van Asten, Henriët van Middendorp, Samuël Verkerk, Myrte Breukink, Carel C B Hoyng, Andrea W Evers, B Jeroen Klevering; Are intravitreal injections with ultrathin 33G needles less painful?. Invest. Ophthalmol. Vis. Sci. 2014;55(13):581.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose: Intravitreal injections (IVI) have become indispensible in ophthalmologic practice. Even though IVI is an effective treatment for many ocular diseases, patients often perceive the procedure as painful and stressful. The goal of this study was to investigate whether pain levels from IVI can be reduced by injecting with a 33G needle as compared to the commonly used 30G needle. In addition, several psychological factors associated with pain were analyzed to identify possible areas for improvement of the IVI procedure.

Methods: This randomized crossover trial included 36 patients who were scheduled for 2 IVIs with VEGF-inhibitors 4 weeks apart. All patients received injections with both the 30G and the 33G needle, but the order in which they were administered was randomized. Immediately following the injection, patients rated the IVI pain score on a 0-10 numeric rating scale. Prior to both IVIs, anxiety and expectations of pain were assessed. After each injection, patients rated their expectations of consequences of the IVI and overall experience. Irregularities that occurred during the procedure were recorded.

Results: The 33G needle did not result in lower IVI pain scores compared to the 30G needle (2.7 vs. 3.1, p=0.758), but did tend to cause less vitreal reflux (0 vs. 5 times, p=0.054). Factors associated with more pain during IVI were: anxiety, expecting more pain and discomfort, low rating of the clinic visit, expecting negative consequences from the injection, and female gender.

Conclusions: Reducing needle gauge from 30G to 33G does not reduce pain from IVIs. Increased efforts aimed at reducing anxiety and patient information could improve the subjective experience of the IVI procedure.

Keywords: 561 injection • 465 clinical (human) or epidemiologic studies: systems/equipment/techniques  
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