Effects of Intravitreal Injection Needle Diameter on the Intraocular Pressure

Year 2018, Volume: 23 Issue: 3, 143 - 146, 26.09.2018

Mehmet Coşkun

https://doi.org/10.21673/anadoluklin.378416

Cited By: 1

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. 

Keywords

intravitreal injection, intraocular pressure

İntravitreal Enjeksiyon İğnesi Çapının Göz İçi Basıncına Etkisi

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.

Keywords

İntravitreal enjeksiyon, göziçi basıncı

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.