Korean J Ophthalmol.  2015 Jun;29(3):190-194. 10.3341/kjo.2015.29.3.190.

Assessment of Patient Pain Experience during Intravitreal 27-Gauge Bevacizumab and 30-Gauge Ranibizumab Injection

• Guler M
• Bilgin B
• Capkin M
• Simsek A
• Bilak S

• KMID: 2363758
• DOI: http://doi.org/10.3341/kjo.2015.29.3.190

Abstract

PURPOSE
To compare pain scores of patients during intravitreal 27-gauge bevacizumab and 30-gauge ranibizumab injection procedures.
METHODS
Seventy eyes of 70 patients who had not previously undergone intravitreal anti-vascular endothelial growth factor therapy were included in this study. Thirty-five patients received ranibizumab and 35 patients received bevacizumab. The diagnoses of the patients were: 27 age related macular degeneration, 15 diabetic macular edema, 9 diabetic vitreous hemorrhage, 6 central retinal vein occlusion, 11 branch retinal vein occlusion and 2 central serous chorioretinopathy. Bevacizumab (1.25 mg/0.05 mL) was injected into the vitreous cavity using a 27-gauge needle, and ranibizumab (0.5 mg/0.05 mL) was injected with 30-gauge needle. Patients were asked just after the injection to rate their perceived pain during the injection using the visual analogue scale (VAS) of 0 (no pain) to 10 (unbearable/worst pain). The average of these scores was used as the primary outcome.
RESULTS
The VAS pain scores in the ranibizumab and bevacizumab groups were 1.06 +/- 0.91 (range, 0 to 3) and 1.94 +/- 1.55 (range, 0 to 7), respectively, a significant difference (p = 0.005). Patients <65 and > or =65 years of age in both the ranibizumab and bevacizumab groups were then compared. For patients <65, there was a significant difference in the average VAS pain scores between groups (p = 0.003). However, for patients > or =65 years, there was not a significant difference in the average VAS pain scores between groups (p = 0.238). Female and male patients in both ranibizumab and bevacizumab groups were also compared. For female patients, there was a significant difference in the average VAS pain scores between groups (p = 0.016), although not for male patients (p = 0.078).
CONCLUSIONS
Thirty-gauge intravitreal injection is more comfortable than 27-gauge injection. Injection of bevacizumab with 30-gauge needle syringes may be more tolerable for patients.

Keyword

Bevacizumab; Intravitreal injections; Pain; Ranibizumab; Visual analogue scale

MeSH Terms

Aged
Aged, 80 and over
Angiogenesis Inhibitors/*administration & dosage
Antibodies, Monoclonal, Humanized/*administration & dosage
Bevacizumab/*administration & dosage
Diabetic Retinopathy/drug therapy/physiopathology
Female
Humans
*Intravitreal Injections
Macular Degeneration/drug therapy/physiopathology
Macular Edema/drug therapy/physiopathology
Male
Middle Aged
Pain Measurement
Ranibizumab/*administration & dosage
Retinal Vein Occlusion/drug therapy/physiopathology
Angiogenesis Inhibitors
Antibodies, Monoclonal, Humanized
Bevacizumab
Ranibizumab

Figure

• 

  Fig. 1 Box-plot showing the distribution of mean visual analog scale values in the 30-gauge ranibizumab and 27-gauge bevacizumab groups. The black lines in the diagram illustrate the median values of the groups.

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