Comparative Study of Analgesic Effectiveness Using Three Different Anesthetic Techniques for Intravitreal Injection of Bevacizumab

Cintra, Léssia P.; Lucena, L. R.; Silva, José A. Da; Costa, R. A.; Jorge, Rodrigo

doi:10.3928/15428877-20090101-05

Cited by 41 publications

(45 citation statements)

References 20 publications

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“…In fact, pain score associated with intravitreal injections of anti-VEGF agents in patients with diabetic retinopathy and neovascular age-related macular degeneration (ARMD) ranges from 0 to 22 (7) , while pain level associated with a PRP session ranges from 10 to 90 (6) . This difference may be explained by the longer pain stimulus during a PRP session.…”

Section: Resultsmentioning

confidence: 99%

“…This difference may be explained by the longer pain stimulus during a PRP session. Another hypothesis is that there may be direct stimulation of the long ciliary nerves during a PRP session (especially if laser applied in the retina periphery at 3 and 9 o'clock meridians) usually merely under topical anesthesia for PRP contact lens positioning, while during intravitreal injections there would be needle conjunctival and uveal nociceptors stimulation, usually partially blocked by topical anesthesia (7) . …”

Section: Resultsmentioning

confidence: 99%

“…Fifteen minutes after the end of retreatment (PRP session or retreatment IVR injection), a masked examiner used a 100-degree Visual Analog Scale (VAS) for pain score estimation (7) . The numbers of the scale were visible only on the examiner's side, so that patients could not choose the same number to guide pain scores.…”

Section: Methodsmentioning

confidence: 99%

“…However, both procedures (PRP and injection) may induce discomfort and pain. Pain regarding PRP treatment is a well-recognized concern and may even prevent its completion (6) , while pain regarding intravitreal injection may disturb patient compliance and peribulbar block may be necessary for uncooperative patients (7) . Since intravitreal injection has become a trendy alternative therapeutic strategy and PRP is the standard of care for high-risk PDR, we decided to compare pain related to both procedures in the management of patients with PDR.…”

Section: Introductionmentioning

confidence: 99%

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Panretinal photocoagulation versus intravitreal injection retreatment pain in high-risk proliferative diabetic retinopathy

Lucena¹,

Filho²,

Messias³

et al. 2013

Arq. Bras. Oftalmol.

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The present study was part of a master degree thesis from C. R. Lucena. Review Board approval: 11976/2008.Clinical Trial register: NCT01009021. ABSTRACTPurpose: To compare pain related to intravitreal injection and panretinal photocoagulation in the management of patients with high-risk proliferative diabetic retinopathy. Methods: Prospective study including patients with high-risk proliferative diabetic retinopathy and no prior laser treatment randomly assigned to receive panretinal photocoagulation (PRP group) or panretinal photocoagulation plus intravitreal ranibizumab (PRPplus group). In all patients, panretinal photocoagulation was administered in two sessions (weeks 0 and 2), and intravitreal ranibizumab was administered at the end of the first laser session in the PRPplus group. Retreatment was performed at weeks 16 and 32 if active new vessels were detected at fluorescein angiography. Patients in the PRPplus group received intravitreal ranibizumab and patients in the PRP group received 500-μm additional spots per quadrant of active new vessels. After the end of retreatment, a 100-degree Visual Analog Scale was used for pain score estimation. The patient was asked about the intensity of pain during the whole procedure (retinal photocoagulation session or intravitreal ranibizumab injection). Statistics for pain score comparison were performed using a non-parametric test (Wilcoxon rank sums). Results: Seventeen patients from PRPplus and 14 from PRP group were evaluated for pain scores. There were no significant differences between both groups regarding gender, glycosylated hemoglobin and disease duration. Mean intravitreal injection pain (±SEM) was 4.7 ± 2.1 and was significantly lower (p<0.0001) than mean panretinal photocoagulation pain (60.8 ± 7.8). Twelve out of 17 patients from the PRPplus group referred intensity pain score of zero, while the minimal score found in PRP group was found in one patient with 10.5. Conclusion:In patients with high-risk proliferative diabetic retinopathy who needed retreatment for persistent new vessels, there was more comfort for the patient when retreatment was performed with an intravitreal injection in comparison with retinal photocoagulation. Further larger studies are necessary to confirm our preliminary findings. (60,8 ± 7,8 RESUMO Objetivo: Comparar a dor relacionada à injeção intravítrea e panfotocoagulação no tratamento de pacientes com retinopatia diabética proliferativa de alto risco. Métodos: Estudo prospectivo incluindo pacientes com retinopatia diabética proliferativa de alto risco e nenhum tratamento a laser prévio aleatoriamente designados para receber panfotocoagulação retiniana (grupo PRP) ou panfotocoagulação e ra nibizumabe intravítreo (grupo PRPplus). Em todos os pacientes, a panfotocoagulação foi administrada em duas sessões (semanas 0 e 2), e ranibizumabe intravítreo foi administrado no final da primeira sessão de laser no grupo PRPplus. Retratamento foi realizado nas semanas 16 e 32 se neovasos ativos fossem detectados na angiofluoresceinografia,...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Panretinal photocoagulation versus intravitreal injection retreatment pain in high-risk proliferative diabetic retinopathy

Lucena¹,

Filho²,

Messias³

et al. 2013

Arq. Bras. Oftalmol.

Self Cite

View full text Add to dashboard Cite

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“…[18][19][20][21] It has also been successfully used in ophthalmological studies evaluating pain associated with ocular surgery, intravitreal injections, and topical therapies. 17,[22][23][24][25][26][27][28] The patients received an explanation of the VAS before the injection, and reported immediately following the procedure the degree of pain they felt during the injection.…”

Section: Data Collectionmentioning

confidence: 99%

Evaluation of pain during intravitreal Ozurdex injections vs intravitreal bevacizumab injections

Moisseiev

Regenbogen

Rabinovitch

et al. 2014

Eye

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Purpose The purpose was to evaluate the pain associated with intravitreal Ozurdex injections, and to compare it with that associated with intravitreal bevacizumab injections. Methods The study included 57 eyes of 57 patients who received an intravitreal Ozurdex injection at our institution. Pain was measured by the visual analog scale (VAS). Additional parameters recorded included age, sex, indication for the injection, number of previous Ozurdex injections in the study eye, presence of diabetes mellitus, and lens status. Data were compared with a 2 : 1 sexand age-matched control group of 114 patients who received intravitreal bevacizumab injections. Results Indications for injection included diabetic macular edema (40.4%) and macular edema secondary to central and branch retinal vein occlusion (28% and 31.6%, respectively). Pain scores on the VAS ranged from 0 to 90, with a mean of 20.8±20.3. There was no significant difference in pain between Ozurdex and bevacizumab injections. Pseudophakia was correlated with increased pain in Ozurdex injections. Conclusions This is the first series evaluating the pain associated with intravitreal Ozurdex injections. Despite a larger needle gauge and tunneled injection technique, intravitreal injection of Ozurdex is not associated with increased pain compared with bevacizumab. This finding may be a potential advantage for Ozurdex, and may serve to improve patient compliance with future long-term treatment protocols.

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Systematic review: non-adherence and non-persistence in intravitreal treatment

Ehlken

Ziemssen

Eter

et al. 2020

Graefes Arch Clin Exp Ophthalmol

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Purpose Intravitreal injection of VEGF inhibitors has become the standard of care for different macular diseases within the last years resulting in improved visual outcomes. Under real-life conditions, however, the necessity for frequent retreatments and reexaminations poses a burden for patients and treatment centers. Non-adherence and non-persistence to intravitreal treatment may lead to inferior clinical outcomes, and knowledge of contributing factors is crucial to improve adherence. This systematic review analyzes current literature for potential factors involved in non-adherence and non-persistence. Methods A systematic search was conducted in PubMed and Embase including three different aspects of intravitreal injection therapy: (1) diseases with intravitreal injections as treatment, (2) intravitreal injection, and (3) aspects of therapy adherence or therapy persistence. Data from identified quantitative studies were further extracted and grouped according to WHO criteria (condition, socio-economy, therapy, patient, and health system). The methodological quality of identified studies was graded. Identified qualitative studies (i.e., interviews) were descriptively analyzed and their findings narratively reported. Results Twenty-four publications were included. In 16 of those publications, a quantitative data analysis was conducted, analyzing factors associated with non-adherence. Worse visual acuity at baseline and unfavorable development of visual acuity, higher age, and greater distance to the treatment center were associated with non-adherence, while there was inconsistent evidence for an association of comorbidity. In qualitative studies, high follow-up/treatment burden, fear and anxiety, disappointed patient expectations, and lack of motivation to continue treatment were reported as reasons for non-persistence. Conclusions Knowledge of potential barriers in IVT treatment may improve adherence and potentially clinical results. Improvements can be achieved particularly in the healthcare complex (organizational improvements) and the “patient” complex by establishing realistic expectations. Recurrent education of the patient may be necessary.

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Comparative Study of Analgesic Effectiveness Using Three Different Anesthetic Techniques for Intravitreal Injection of Bevacizumab

Cited by 41 publications

References 20 publications

Panretinal photocoagulation versus intravitreal injection retreatment pain in high-risk proliferative diabetic retinopathy

Panretinal photocoagulation versus intravitreal injection retreatment pain in high-risk proliferative diabetic retinopathy

Evaluation of pain during intravitreal Ozurdex injections vs intravitreal bevacizumab injections

Systematic review: non-adherence and non-persistence in intravitreal treatment

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