Abstract
Purpose :
To evaluate the different factors correlating with pain severity following intravitreal injections.
Methods :
All injections were performed by the same doctor (AZS). Patients were anesthetized either with drops only or with a subconjunctival injection of 0.1 cc of lidocaine 2%. The injections were performed with either a 30 or 32 gauge needle. Patients were randomly assigned into four groups: topical with 30 G needle (group A). topical with 32 G needle (group B), subconjunctival with 30 G (group C) and subconjunctival with 32 G (Group D). The visual analog scale (VAS) was used to assess pain. Primary study variables were the relationship between pain severity and anesthesia type, needle size, number of previous injections, age, sex, lens status and indication for injection. Secondary variables included best-corrected visual acuity (BCVA) and central macular thickness (CMT) changes 1 month post injection.
Results :
100 eyes of 100 patients were included in the study. Each group included 25 eyes. Sixty two patients were females (62%) and 38 were males (38%). Overall mean pain score was 2.73 ± 1.89. Indications for injection were diabetic macular edema (81%), neovascular age-related macular degeneration (6%), and macular edema secondary to retinal vein occlusion (13%). The mean VAS scores in groups A, B, C and D were 4.1 ± 2, 2.9 ± 2.3, 1.9 ± 1.7 and 1.7 ± 2.1, respectively. Pain severity was significantly correlated with anesthetic type (p < 0.001) and needle size (p < 0.001); A negative correlation existed between pain score and number of previous injections (p = 0.03). Pain severity was not associated with age (p = 0.59), sex (p= 0.45), lens status (p = 0.48), vitreous reflux (p = 0.65) or indication for injection (p = 0.37). No significant complications were observed.
Conclusions :
Using subconjunctival anesthesia and a smaller needle size were associated with less pain during intravitreal injections. These results need to be validated in larger studies. However, adopting these changes can help increase patient comfort during the injection.
This is a 2021 ARVO Annual Meeting abstract.