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Dennis P Han, Kaitlin C McKenney, Judy E Kim, David V. Weinberg, Ravi S.J. Singh; Clinical Evaluation of the Rapid Access Vitreal Injection (RAVI) Guide: A Hand-held Instrument for Assisting Intravitreal Injections. Invest. Ophthalmol. Vis. Sci. 2016;57(12):2673.
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© ARVO (1962-2015); The Authors (2016-present)
The Rapid Access Vitreal Injection (RAVI) Guide combines the function of the eyelid speculum and measuring caliper into a single instrument for assisting intravitreal injections. The aim of this study was to clinically evaluate the RAVI Guide with respect to patient acceptance, complication rates, and operative goals.
An IRB-approved, prospective study was performed on 54 patients undergoing intravitreal injections of anti-VEGF agents. Patients received use of the RAVI Guide or lid speculum according to physician discretion. Immediately after injection, patients were queried regarding device-related pain using a standard script and the Wong-Baker scoring system, scaled from 0 (no pain) to 10 (agonizing pain). Physician users were queried regarding goals of avoiding needle touch to lashes/lids and guiding needle insertion to the intended site. Sample procedure times were obtained. The unpaired t-test and chi-squared test were used.
The RAVI Guide was used in 32 patients and speculum/caliper used in 22 patients. Mean device-related pain score (+/-S.D.) for the RAVI Guide was 0.6+/-1.2, and for the lid speculum was 0.7+/-0.9 (p=N.S.), [95% CI of difference, -0.7 to 0.6]. Of the 30 RAVI Guide patients who could recall previous use of a speculum, 25 indicated it was more comfortable than the speculum, and 5, the same. A pain free experience (score 0) was obtained in 23 (72%) RAVI Guide patients and 14 (64%) speculum patients (p=N.S.). A pain score of 2 or higher was obtained in 5 (16%) RAVI Guide patients and 7 (32%) speculum patients (p=0.16). Mean durations (+/-S.D.) of the injection procedure for the RAVI Guide and speculum, respectively, were 28+/-3 and 73+/-15 seconds (p=0.0007) for one physician, and 11+/-1 and 25+/-2 seconds (p=0.03 x 10-9) for another. Operative goals were achieved in all patients. No visually significant operative complications were observed with either device.
The RAVI Guide appeared equivalent to the lid speculum in achieving operative goals, with similarly low pain scores. A trend toward a reduced rate of significant pain was observed for the RAVI Guide. The Guide was also associated with significant reduction of physician cycle time. The RAVI Guide may be a viable option for providing rapid access and measurement for intravitreal injections in appropriately selected patients.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
RAVI Guide in position
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