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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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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.
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.
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.
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.
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