Journal of Current Glaucoma Practice

Register      Login

VOLUME 11 , ISSUE 2 ( May-August, 2017 ) > List of Articles

ORIGINAL REASEARCH

Intravitreal Injections of Bevacizumab: The Impact of Needle Size in Intraocular Pressure and Pain

Mónica Loureiro, Rita Matos, Paula Sepulveda, Dália Meira

Citation Information : Loureiro M, Matos R, Sepulveda P, Meira D. Intravitreal Injections of Bevacizumab: The Impact of Needle Size in Intraocular Pressure and Pain. J Curr Glaucoma Pract 2017; 11 (2):38-41.

DOI: 10.5005/jp-journals-10028-1220

License: CC BY 3.0

Published Online: 00-08-2017

Copyright Statement:  Copyright © 2017; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Aim

To compare the effect of 30-gauge vs 27-gauge needle size on intraocular pressure (IOP) rise and patients’ pain experience after intravitreal injection (IVI) of bevacizumab.

Materials and methods

Cross-sectional, randomized, double-armed study. Patients were randomized to IVI with 30-gauge or 27-gauge needle. The IOP was measured pre and post IVI. Patients’ pain was graded using the visual analog scale (VAS).

Results

A total of 54 eyes were included. The IVI caused a significant IOP rise in both groups (p < 0.001). In the 30-gauge group, the mean pre- and postinjection IOP was 16.3 ± 3.6 mm Hg and 24.1 ± 9.0 mm Hg. The corresponding figures in the 27-gauge group were 18.0 ± 2.54 (p = 0.26) and 23.1 ± 7.5 mm Hg (p = 0.66). In the 30-gauge group, the mean VAS pain score was 3.2 ± 2.6 compared to 3.0 ± 2.5 in the 27-gauge group (p = 0.78).

Conclusion

The IVI caused a significant rise in IOP after the injection, independently of the needle size used. The 27-gauge needle coursed with lower postinjection IOP without prejudice of the patient comfort.

Clinical significance

The IVI with 27-gauge may be considered for glaucomatous eyes (higher risk eyes), for which IOP spikes are not recommended.

How to cite this article

Loureiro M, Matos R, Sepulveda P, Meira D. Intravitreal Injections of Bevacizumab: The Impact of Needle Size in Intraocular Pressure and Pain. J Curr Glaucoma Pract 2017;11(2):38-41.


PDF Share
  1. Intravitreal injections of therapeutic agents. Retina 2009 Jul-Aug;29(7):875-912.
  2. Intravitreal ranibizumab in daily clinical practice for age-related macular degeneration: treatment of exudative age-related macular degeneration in real life. Ophthalmologica 2015;234(1):26-32.
  3. Intravitreal bevacizumab (Avastin) in the treatment of proliferative diabetic retinopathy. Ophthalmology 2006 Oct;113(10):1695.e1-e15.
  4. Optimal treatment of retinal vein occlusion: canadian expert consensus. ophthalmologica 2015;234(1):6-25.
  5. Ranibizumab and bevacizumab for neovascular age-related macular degeneration. N Engl J Med 2011 May;364(20):1897-1908.
  6. Retina 2007 Oct;27(8):1044-1047.
  7. Eye (Lond) 2009 Jan;23(1):181-185.
  8. Intraocular pressure rise after anti-VEGF treatment: prevalence, possible mechanisms and correlations. J Curr Glaucoma Pract 2013 Jan-Apr;7(1):19-24.
  9. Predictors of sustained intraocular pressure elevation in eyes receiving intravitreal anti-vascular endothelial growth factor therapy. Am J Ophthalmol 2014 Aug;158(2):319-327.
  10. Intraocular pressure in eyes receiving intravitreal antivascular endothelial growth factor injections. Ophthalmologica 2015;233(3-4):162-168.
  11. Association between needle size, postinjection reflux, and intraocular pressure spikes after intravitreal injections. Retina 2015 Jul;35(7):1401-1406.
  12. Scleral penetration force requirements for commonly used intravitreal needles. Eye (Lond) 2007 Sep;21(9):1210-1211.
  13. Can patients accurately read a visual analog pain scale? Am J Emerg Med 2003 Nov;21(7):515-519.
  14. Intravitreal injection anesthesia-comparison of different topical agents: a prospective randomized controlled trial. Am J Opthalmol 2011 Feb;151(2):333-337.
  15. Comparative study of analgesic effectiveness using three different anesthetic techniques for intravitreal injection of bevacizumab. Ophthalmic Surg Lasers Imaging 2009 Jan-Feb;40(1):13-18.
  16. Survey of intravitreal injection techniques among retinal specialists in the United States. Am J Ophthalmol 2011 Feb;151(2):329-332.
  17. Short-term intraocular pressure changes immediately after intravitreal injections of anti-vascular endothelial growth factor agents. Am J Ophthalmol 2008 Dec;146(6):930-934.
  18. Tunneled versus straight intravitreal injection: intraocular pressure changes, vitreous reflux, and patient discomfort. Retina 2009 Sep;29(8):1175-1181.
  19. Assessment of patient pain experience during intravitreal 27-gauge bevacizumab and 30-gauge ranibizumab injection. Korean J Ophthalmol 2015 Jun;29(3):190-194.
  20. Effect of needle type and injection technique on pain level and vitreal reflux in intravitreal injection. J Ocul Pharmacol Ther 2011 Apr;27:197-203.
  21. Factors affecting patients’ pain intensity during in office intravitreal injection procedure. Retina 2012 Apr;32(4):696-700.
  22. Needle size in intravitreal injections–pain evaluation of a randomized clinical trial. Acta Opthalmol 2016 Mar;94(2):198-202.
  23. Influence of axial length and post-injection reflux on sustained intraocular pressure elevation as a result of intravitreal anti-vascular endothelial growth factor therapy. Retina 2014 Mar;34(3):519-524.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.