First Author: I.Mantel SWITZERLAND
Co Author(s): I. Nguyen F. Fabro S. Ezziat C. Bergin A. Ambresin
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Intravitreal injections under topical anaesthesia are sometimes reported to be painful. The aim of this study was to quantify the incidence and degree of pain during intravitreal injections, and to examine potential risk factors for elevated pain.
Prospective observational study in patients undergoing intravitreal injection with anti-vascular endothelial growth factor
After informed consent, patients responded to a questionnaire on: current well-being, anxiety and understanding prior to the injection and on degree of pain experienced after the injection. The surgeon completed a questionnaire based on his assessment of the patient. Additional data included age, gender, allergies, medication, ocular history, redness of the eye, the treated ocular pathology, the drug, and timing between anaesthesia and injection. The injection was performed under topical anaesthesia using a 30 Gauge needle
Out of the 228 participants in the study, 132 patients (57.9%) reported pain to some degree, which was considered severe (>5 on a scale from 0 to 10) by 11 patients (5%). After univariate analysis, the risk factors for elevated self-assessed pain included self-reported degree of preoperative anxiety (p 0.00), pain experienced during prior intravitreal injections (p 0.00), conjonctival hyperemia (p 0.08), the chronic use of ocular drops (p 0.01), and the patient's understanding (p 0.01). The final model after multivariate analysis included the self-reported degree of preoperative anxiety (p-value=0.00) and pain experienced during prior intravitreal injections (p-value=0.00).
Pain during intravitreal injections might occur in more than 50% of patients despite adequate anaesthesia. The main factors are the patient’s anxiety and previously painful injections. Such knowledge might help to improve the care of patients requiring multiple intravitreal injections.