Abstract
Purpose: To compare reflux, intraocular pressure (IOP) variation and pain following intravitreal (IV) injections using 30-gauge and 32-gauge needles in patients with retinal pathologies in Saudi Arabia.Methods: A double-blind randomized clinical trial was conducted in 2018. Participants were randomized to receive IV injections of Ranibizumab using 30-gauge (Gr1) or 32-gauge (Gr2) needles. The amount of reflux of injected material, IOP before (IOP1) and five minutes after injection (IOP2) were measured. The patient-perceived pain score was assessed using a visual analogue score (VAS). Outcome variables were compared.Results: The study sample was comprised of 86 eyes (86 patients) in each group. Gender (P=0.76), laterality (P=0.55) and age (P=1.0) were not different between groups. The reflux in Gr1 [34.9% (95% confidence interval {CI}, 24.8; 45.0)] was significantly higher compared to Gr2 [22.1% (95% CI, 13.3; 30.9)] (P=0.007). The median pain score was 1 in both Gr1 [interquartile range (IQR) 1.0: 3.0] and Gr2 (IQR 0.0; 2.0) (P=0.04). Among 56 eyes without reflux in Gr1, the IOP1 and IOP2 were 13.6±2.7 mmHg and 16.4±5.0 mmHg, respectively. Among 67 eyes without reflux in Gr2, the IOP1 and IOP2 were 13.6±2.9 mmHg and 17.0±5.2 mmHg, respectively. The change in percentage in IOP in Gr1 and Gr2 was not significantly different (Mann Whiney P=0.3).Conclusions: IV injection given by 30-gauge needle compared to 32-gauge needle resulted in greater patient-perceived pain and more reflux of injected material from the injection site. An increase in IOP was not associated with the gauge of the needle used for IV injection.
Highlights
IntroductionAnti-vascular endothelial growth factor (VEGF) compounds are the initial treatment for diabetic macular edema (DME) with foveal involvement
IV injection given by 30-gauge needle compared to 32-gauge needle resulted in greater patientperceived pain and more reflux of injected material from the injection site
An increase in intraocular pressure (IOP) was not associated with the gauge of the needle used for IV injection
Summary
Anti-vascular endothelial growth factor (VEGF) compounds are the initial treatment for diabetic macular edema (DME) with foveal involvement. These compounds can be used as isolated treatment or combined with photocoagulation [1,2]. Intravitreal (IV) injections of anti-VEGF compounds are performed on an outpatient basis for a number of other retinal pathologies [3,4]. For optimum availability of anti-VEGF medication in the vitreous cavity proximal to the site of pathology, different routes, different sites and different sized injections (gauge) have been investigated [10,11,12]. Reflux occurs soon after intravitreal injection and it contains the injected material and vitreous. The reflux can vary by size of entry in the sclera and other layers of the globe depending on the needle gauge
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