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Effects of Intravitreal Injection Needle Diameter on the Intraocular Pressure

Year 2018, , 143 - 146, 26.09.2018
https://doi.org/10.21673/anadoluklin.378416

Abstract

Aim: This study aimed to investigate the effects of injection needle diameter on the intraocular pressure
in patients who underwent intravitreal injection.

Materials and Methods: One hundred and seven eyes of 107 patients who underwent intravitreal
aflibercept (IVA) injection for diabetic retinopathy or macular edema were included. Fifty-two eyes
of the 52 patients for whom a 26-gauge (G) needle was used were designated as Group 1 and 55
eyes of the 55 patients for whom a 30-G needle was used as Group 2. Intraocular pressure (IOP) was
measured before (BIOP) and after (AIOP) the blepharostat placement (AIOP) and 1 minute after the
injection (EIOP).

Results: There were 25 males and 27 females in Group 1 and 26 males and 29 females in Group 2
(p=0.93). The mean age was 56.40±7.62 years for Group 1 and 56.58±6.91 years for Group 2 (p=0.90).
The mean BIOP and AIOP were respectively 18.56±3.91 mmHg and 21.94±4.27 mmHg for Group 1
while 18.10±3.80 mmHg and 20.63±4.91 mmHg for Group 2; and the differences were not statistically
significant (p=0.63 and p=0.14, respectively). The mean EIOP was 34.84±16.46 mmHg for Group 1
and 47.05±10.02 mmHg for Group 2; and the difference was statistically significant (p=0.001). The
mean EIOP–AIOP and EIOP–BIOP differences were respectively 12.86±17.63 mmHg and 15.80±16.65
mmHg for Group 1 (p=0.001) and 25.87±9.95 mmHg and 28.25±10.09 mmHg for Group 2 (p=0.001).

Discussion and Conclusion: It was seen that less fluctuation was caused in the intraocular pressure
by use of a 26-G compared to a 30-G needle during the injection of the same intravitreal drugs in
demographically similar patients. 

References

  • KAYNAKLAR 1. Brand CS. Management of retinal vascular diseases: a patient-centric approach. Eye (Lond) 2012;26:1-16. 2. Alakuş MF, Taş M, Öner V, et al. Diabetik Maküla Ödeminde İntravitreal Bevacizumab Etkinliğininin Değerlendirilmesi. Retina Vitreus 2012;1:35-40. 3. Tolentino M. Systemic and ocular safety of intravitreal anti-VEGF therapies for ocular neovascular disease. Surv Ophthalmol 2011;56:95-113. 4. Wong LJ, Desai RU, Jain A, et al. Surveillance for potential adverse events associated with the use of intravitreal bevacizumab for retinal and choroidal vascular disease. Retina 2008;28:1151-1158. 5. Bakri SJ, Pulido JS, McCannel CA, Hodge DO, Diehl N, Hillemeier J. Immediate intraocular pressure changes following intravitreal injections of triamcinolone, pegaptanib, and bevacizumab. Eye 2009;23:181-185. 6. Sharei V, Höhn F, Köhler T et al. Course of intraocular pressure after intravitreal injection of 0.05 mL ranibizumab (Lucentis). Eur J Ophthalmol 2010;20:174- 179. 7. Kotliar K, Maier M, Bauer S et al. Effect of intravitreal injections and volume changes on intraocular pressure: clinical results and biomechanical model. Acta Ophthalmol Scand 2007;85:777-781. 8. Gismondi M, Salati C, Salvetat ML et al. Short term effect of intravitreal injection of Ranibizumab (Lucentis) on intraocular pressure. J Glaucoma 2009;18:658- 661. 9. Höhn F, Mirshahi A. Impact of injection techniques on intraocular pressure (IOP) increase after intravitreal ranibizumab application. Graefes Arch Clin Exp Ophthalmol 2010;248:1371-1375. 10. Meyer CH, Holz FG. Preclinical aspects of anti-VEGF agents for the treatment of wet AMD: ranibizumab and bevacizumab. Eye (Lond) 2011;25:661-672 11. Whitacre MM, Stein R.: Surces of error with use of Goldmann-type tonometers. Surv Ophthalmol. 1993;38:1-30. 12. Satıcı A, Oğuz H, Gürler B.: Göz içi basınç ölçümünde Goldmann aplanasyon tonometresi ile Tono-Pen ve nonkontakt tonometre değerlerinin karşılaştırılması. T Oft Gaz. 1997;27:321-324. 13. Özdemir N, Tekin A, Ersöz TR. et al.: Tono-Pen tonometresi ile Goldmann applanasyon tonometresinin klinik olarak karşılaştırılması. MN Ophthalmology. 1997;4:168-170. 14. Chritoffersen T, Fors T, Ringberg U. et al.: Tonometry in the general practice setting(1):Tono-Pen compared to Goldmann applanation tonometry. Acta Ophthalmol. 1993;71:103-108. 15. 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 May-Aug;11(2):38-41 16. El Chehab H, Agard E, Russo A, Boujnah Y, Dot C.Intraocular Pressure Spikes after Aflibercept Intravitreal Injections. Ophthalmologica. 2016;236(1):43-7
  • 17. Haas P, Falkner-Radler C, Wimpissinger B, Malina M, Binder S.Needle size in intravitreal injections - pain evaluation of a randomized clinical trial. Acta Ophthalmol. 2016 Mar;94(2):198-202.
  • 18.Güler M, Bilgin B, Çapkın M, Şimşek A, Bilak Ş. Assessment of patient pain experience during intravitreal 27-gauge bevacizumab and 30-gauge ranibizumab injection. Korean J Ophthalmol. 2015 Jun;29(3):190-4.
  • 19.van Asten F, van Middendorp H, Verkerk S et al. Are Intravitreal Injectıons wıth Ultrathın 33 G Needles Less Paınful Than Commonly Used 30 G Needles? Retina. 2015 Sep;35(9):1778-85
  • 20. Pang CE, Mrejen S, Hoang QV, Sorenson JA, Freund KB. Assocıation Between Needle Sıze,Postinjection Reflux and Intraocular Pressure Spıkes After Intravitreal Injections. Retina. 2015 Jul;35(7):1401-6.
  • 21.Yannuzzi NA, Patel SN, Bhavsar KV, Sugiguchi F, Freund KB.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.

İntravitreal Enjeksiyon İğnesi Çapının Göz İçi Basıncına Etkisi

Year 2018, , 143 - 146, 26.09.2018
https://doi.org/10.21673/anadoluklin.378416

Abstract

Amaç: İntravitreal enjeksiyon yapılan hastalarda enjeksiyon iğnesi çapının göz içi basıncına etkisini incelemek amaçlanmıştır.

Gereç ve Yöntemler: Diyabetik retinopati ve makula ödemi nedeniyle intravitreal aflibersept (IVA) enjeksiyonu uygulanan 107 hastanın 107 gözü çalışmaya dahil edildi. Yirmi altı gauge (G) iğne kullanılan 52 hastanın 52 gözü Grup 1 olarak, 30 G iğne kullanılan 55 hastanın 55 gözü Grup 2 olarak değerlendirildi. Göz içi basıncı (GİB) blefarosta takılmadan önce (ÖGİB), blefarosta takıldıktan sonra (BGİB) ve enjeksiyon sonrası 1. dakikada (EGİB) ölçüldü.

Bulgular: Grup 1’de 25 erkek, 27 kadın, Grup 2’de 26 erkek, 29 kadın hasta mevcuttu (p=0,93). Yaş ortalaması Grup 1’de 56,40±7,62 yıl, Grup 2’de 56,58±6,91 yıldı (p=0,90). Ortalama ÖGİB ve BGİB sırasıyla Grup 1’de 18,56±3,91 mmHg ve 21,94±4,27 mmHg, Grup 2’de 18,10±3,80 mmHg ve 20,63±4,91 mmHg idi; aradaki farklar istatistiksel olarak anlamlı değildi (sırasıyla, p=0,63 ve p=0,14). Ortalama EGİB değerleri ise Grup 1’de 34,84±16,46 mmHg, Grup 2’de 47,05±10,02 mmHg olup aradaki fark istatistiksel olarak anlamlıydı (p=0,001). EGİB–BGİB fark ortalaması Grup 1’de 12,86±17,63, Grup 2’de 25,87±9,95 idi (p=0,001). EGİB–ÖGİB fark değerleri ortalaması ise Grup 1’de 15,80±16,65, Grup 2’de 28,25±10,09 olarak tespit edildi (p=0,001) (Tablo 1).

Tartışma ve Sonuç: Demografik benzerlikleri olan ve aynı intravitreal ilaçlar uygulanan hastalarda enjeksiyonun 26 G iğne ile uygulanmasının 30 G iğne ile uygulanmasına göre daha az göz içi basıncı değişimi yaptığı görülmüştür.

References

  • KAYNAKLAR 1. Brand CS. Management of retinal vascular diseases: a patient-centric approach. Eye (Lond) 2012;26:1-16. 2. Alakuş MF, Taş M, Öner V, et al. Diabetik Maküla Ödeminde İntravitreal Bevacizumab Etkinliğininin Değerlendirilmesi. Retina Vitreus 2012;1:35-40. 3. Tolentino M. Systemic and ocular safety of intravitreal anti-VEGF therapies for ocular neovascular disease. Surv Ophthalmol 2011;56:95-113. 4. Wong LJ, Desai RU, Jain A, et al. Surveillance for potential adverse events associated with the use of intravitreal bevacizumab for retinal and choroidal vascular disease. Retina 2008;28:1151-1158. 5. Bakri SJ, Pulido JS, McCannel CA, Hodge DO, Diehl N, Hillemeier J. Immediate intraocular pressure changes following intravitreal injections of triamcinolone, pegaptanib, and bevacizumab. Eye 2009;23:181-185. 6. Sharei V, Höhn F, Köhler T et al. Course of intraocular pressure after intravitreal injection of 0.05 mL ranibizumab (Lucentis). Eur J Ophthalmol 2010;20:174- 179. 7. Kotliar K, Maier M, Bauer S et al. Effect of intravitreal injections and volume changes on intraocular pressure: clinical results and biomechanical model. Acta Ophthalmol Scand 2007;85:777-781. 8. Gismondi M, Salati C, Salvetat ML et al. Short term effect of intravitreal injection of Ranibizumab (Lucentis) on intraocular pressure. J Glaucoma 2009;18:658- 661. 9. Höhn F, Mirshahi A. Impact of injection techniques on intraocular pressure (IOP) increase after intravitreal ranibizumab application. Graefes Arch Clin Exp Ophthalmol 2010;248:1371-1375. 10. Meyer CH, Holz FG. Preclinical aspects of anti-VEGF agents for the treatment of wet AMD: ranibizumab and bevacizumab. Eye (Lond) 2011;25:661-672 11. Whitacre MM, Stein R.: Surces of error with use of Goldmann-type tonometers. Surv Ophthalmol. 1993;38:1-30. 12. Satıcı A, Oğuz H, Gürler B.: Göz içi basınç ölçümünde Goldmann aplanasyon tonometresi ile Tono-Pen ve nonkontakt tonometre değerlerinin karşılaştırılması. T Oft Gaz. 1997;27:321-324. 13. Özdemir N, Tekin A, Ersöz TR. et al.: Tono-Pen tonometresi ile Goldmann applanasyon tonometresinin klinik olarak karşılaştırılması. MN Ophthalmology. 1997;4:168-170. 14. Chritoffersen T, Fors T, Ringberg U. et al.: Tonometry in the general practice setting(1):Tono-Pen compared to Goldmann applanation tonometry. Acta Ophthalmol. 1993;71:103-108. 15. 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 May-Aug;11(2):38-41 16. El Chehab H, Agard E, Russo A, Boujnah Y, Dot C.Intraocular Pressure Spikes after Aflibercept Intravitreal Injections. Ophthalmologica. 2016;236(1):43-7
  • 17. Haas P, Falkner-Radler C, Wimpissinger B, Malina M, Binder S.Needle size in intravitreal injections - pain evaluation of a randomized clinical trial. Acta Ophthalmol. 2016 Mar;94(2):198-202.
  • 18.Güler M, Bilgin B, Çapkın M, Şimşek A, Bilak Ş. Assessment of patient pain experience during intravitreal 27-gauge bevacizumab and 30-gauge ranibizumab injection. Korean J Ophthalmol. 2015 Jun;29(3):190-4.
  • 19.van Asten F, van Middendorp H, Verkerk S et al. Are Intravitreal Injectıons wıth Ultrathın 33 G Needles Less Paınful Than Commonly Used 30 G Needles? Retina. 2015 Sep;35(9):1778-85
  • 20. Pang CE, Mrejen S, Hoang QV, Sorenson JA, Freund KB. Assocıation Between Needle Sıze,Postinjection Reflux and Intraocular Pressure Spıkes After Intravitreal Injections. Retina. 2015 Jul;35(7):1401-6.
  • 21.Yannuzzi NA, Patel SN, Bhavsar KV, Sugiguchi F, Freund KB.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.
There are 6 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section ORIGINAL ARTICLE
Authors

Mehmet Coşkun This is me

Publication Date September 26, 2018
Acceptance Date April 29, 2018
Published in Issue Year 2018

Cite

Vancouver Coşkun M. İntravitreal Enjeksiyon İğnesi Çapının Göz İçi Basıncına Etkisi. Anadolu Klin. 2018;23(3):143-6.

13151 This Journal licensed under a CC BY-NC (Creative Commons Attribution-NonCommercial 4.0) International License.