Factors Associated with Pain Following Intravitreal Injections

Urfalioglu

Cumhuriyet Medical Journal

2019

To determine the effect of intravitreal injection into different quadrants on pain score and injection comfort. Method: 304 patients were divided into 8 groups that included 38 patients in each. The right and left eyes of the patients were divided into 4 quadrants, superior temporal, inferior temporal, superior nasal, and inferior nasal. Intravitreal injections were performed in the room only used for this purpose and by an experienced ophthalmologist. To eliminate drug-related factors only intravitreal ranibizumab applied patients were included in the study. Injections were performed on one of these quadrants 3.5 mm away from the limbus using 30 gauge needle. All injections were performed under topical proparacaine HCl anesthesia. The severity of the patient's pain after the injection was evaluated by using the visual analog scale. Additionally, the patient's stinging, injection comfort and injection safety were also assessed. Results: 176 (57.9%) of the participants were male and 128 (42.1%) were female. The mean age of all participants was 61,84±12,49 (20-90). Age (p=0,793), gender (p=0,534), pain score (p=0,165), stinging score (p=0,264), patient comfort score (p=0,555), injection safety score (p=0,079) were similar between the groups. Pain (p<0,001) and stinging (p<0,001) scores were higher in females (p<0,001). Patient comfort (p=0,001) and injection safety (p=0,019) scores were lower in females. Conclusions: No difference was found between the quadrants in terms of pain score. Therefore, the physicians may prefer the most comfortable quadrant for themselves and for their patients in intravitreal injection.

Section: Discussionmentioning

confidence: 63%

“…The number of injections, anterior chamber paracentesis, patient anxiety, and visual gain after the first injection was found to be associated with pain in intravitreal injection. 2,6,7 We did not evaluate these variables in our study. Some studies have found a relationship between pain and needle diameter during the injection.…”

Section: Discussionmentioning

confidence: 99%

The effect of intravitreal injection into different quadrants on pain score

Urfalioglu

Cumhuriyet Medical Journal

2019

“…Conflicting results have been reported regarding the effect of age on pain level in patients receiving intravitreal injection. While no correlation was observed in four of the studies, 18 21 31 32 one showed that elderly patients experienced more pain. 33 Two studies showed that level of pain was lower in patients 65 years of age or older.…”

Section: Discussionmentioning

confidence: 83%

Factors associated with pain level in patients receiving intravitreal injection

2021

Purpose: To identify the factors associated with the pain level in patients receiving intravitreal injection. Methods: A total of 120 patients were prospectively evaluated, and 104 were included in the study. Patients were asked to rate their pain intensity from 0 to 10 on the visual analog scale. Factors that were possibly associated with pain level were evaluated using a sociodemographic data form, state anxiety inventory, and the hospital anxiety and depression scale. Results: Of the participants, 54 (51.9%) were female, and 50 (48.1%) were male, with a mean age of 65 ± 9.01 years. There was a positive correlation between pain level and state anxiety scores ( r = 0.30; P < 0.001) and a negative correlation between hospital anxiety score ( r = −0.23; P = 0.02) and hospital depression score ( r = −0.27; P = 0.01). The correlation between pain score and education level was significantly higher in primary and secondary school graduates ( P < 0.01). Smokers were observed to have higher pain scores (6.50 ± 2.21 in smokers and 4.87 ± 2.50 in nonsmokers; P = 0.01). Among diagnostic groups, pain scores were found to be significantly lower in the diabetic retinopathy (DR) group (6.82 ± 1.99 in age-related macular degeneration, 5.94 ± 2.27 in retinal vein occlusion, and 3.58 ± 1.97 in DR; P < 0.001). When pain scores were evaluated according to the drug injected, the group receiving bevacizumab injection was observed to have higher pain scores (7.32 ± 1.81 in bevacizumab, 4.00 ± 2.08 in aflibercept, and 3.92 ± 1.96 in ranibizumab; P < 0.001). Based on the multiple regression analysis, the state anxiety score, hospital anxiety score, hospital depression score, and smoking status were observed not to be significant predictors. The level of education, diagnosis, and active substance were found to have a statistically significant effect on pain perception. Conclusion: In this study, pain levels have been found to be high in smokers, those with a low educational level, individuals receiving bevacizumab for intravitreal injection, and those having a higher level of state anxiety, whereas patients with DR have lower pain scores.

“…Intravitreal injection of Avastin requires a monthly injection, which may lead to discomfort, infections, and other complications. 20 – 22 Using therapeutic ultrasound to deliver Avastin into the eye could eliminate these risks and may allow for drug delivery with fewer complications. 45 Our minimally invasive technology shows promise for delivering macromolecules into the eye.…”

Section: Discussionmentioning

confidence: 99%

“… 13 , 14 Intravitreal injection of anti-VEGF requires a monthly injection, which can lead to patient discomfort, increase chance of postinjection infections, and related complications. 20 – 22 Steroids implants, such as intravitreal triamcinolone (IVTA), Dexamethasone (DEX), and fluocinolone acetonide (FA), are all effective in the treatment of retinal vascular diseases. 19 DEX implants are also effective for the treatment of diabetic retinopathy as an alternative and/or in combination with anti-VEGF therapy.…”

Section: Introductionmentioning

confidence: 99%

Feasibility of Therapeutic Ultrasound Application in Topical Scleral Delivery of Avastin

Almogbil

Nasrallah

Zderic

2021

Trans. Vis. Sci. Tech.

Purpose Macromolecules have been shown to be effective in vision-saving treatments for various ocular diseases, such as age-related macular degeneration and diabetic retinopathy. The current delivery of macromolecules requires frequent intraocular injections and carries a risk of serious adverse effects. Methods We tested the application of therapeutic ultrasound as a minimally invasive approach for the delivery of Avastin into the diseased regions of the eye. Avastin (bevacizumab) is an anti-vascular endothelial growth factor (VEGF) antibody with a molecular weight of 149 kDa. We tested the effectiveness and safety of Avastin delivery through rabbit sclera in vitro using a standard diffusion cell model. Ultrasound at frequencies of 400 kHz or 3 MHz with an intensity of 1 W/cm 2 was applied for the first 5 minutes of 1-hour drug exposure. Sham treatments mimicked the ultrasound treatments, but ultrasound was not turned on. Absorbance measurements of the receiver compartment solution were performed at 280 nm using a spectrophotometer. Results Absorbance measurements indicated no statistical difference between the sham ( n = 13) and 400 kHz ultrasound group ( n = 15) in the delivery of Avastin through the sclera. However, the absorbance values were statistically different ( P < 0.01) between the 3 MHz ultrasound group (0.004, n = 8) and the matched sham group (0.002, n = 7). There was 2.3 times increase in drug delivery in the 3 MHz ultrasound when compared to the corresponding sham group. Histological studies indicated no significant damage in the ultrasound-treated sclera due to ultrasound application. Conclusions Our preliminary results provided support that therapeutic ultrasound may be effective in the delivery of Avastin through the sclera. Translational Relevance Our study offers clinical potential for a minimally invasive retinopathy treatment.