Relationship between Pain and Injection Site during Intravitreal Injection

Kyeong Do Jeong; Jung Hoon Kim; Jae Suk Kim; Je Hyung Hwang

doi:10.3341/jkos.2016.57.6.930

Journal List > J Korean Ophthalmol Soc > v.57(6) > 1010610

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Jeong, Kim, Kim, and Hwang: Relationship between Pain and Injection Site during Intravitreal Injection

Original Article

J Korean Ophthalmol Soc 2016;57(6):930-934.

Published online: 25 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.6.930

Relationship between Pain and Injection Site during Intravitreal Injection

Kyeong Do Jeong, MD, Jung Hoon Kim, MD, Jae Suk Kim, MD, PhD, Je Hyung Hwang, MD

Department of Ophthalmology, Inje University Sanggye Paik Hospital, Seoul, Korea

Address reprint requests to Je Hyung Hwang, MD Department of Ophthalmology, Inje University Sanggye Paik Hospital, #1342 Dongil-ro, Nowon-gu, Seoul 01757, Korea Tel: 82-2-950-1096, Fax: 82-2-935-6904 E-mail: violentviolet15@daum.net

Received 17 March 2016 Revised 8 April 2016 Accepted 9 May 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Using a visual analogue scale, patients pain was compared according to injection site during intravitreal injection.

Methods

A prospective, clinical trial was conducted on 171 eyes of patients experiencing age-related macular degeneration, diabetic retinopathy, retinal vein occlusion, or central serous chorioretinopathy. After determining the anatomic quadrant of the injection site, patients were randomized to receive intravitreal bevacizumab, aflibercept, ranibizumab, or dexamethasone injection. Fifteen minutes after the injection, patients completed a survey about pain using a visual analogue scale from 0 (no pain) to 10 (unbearable pain).

Results

According to the visual analogue scale, pain score was 3.20 at the superotemporal site, 3.03 at the superonasal site, and 2.35 at the inferonasal site. Pain was lowest when injected in an inferotemporal site (p = 0.012).

Conclusions

Intravitreal injection at an inferotemporal site can help reduce patient pain.

Keywords: Intravitreal injection, Pain measurement, Visual analogue scale

References

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Figure 1.

Injection site description. ST = superotemporal; SN = superonasal; IT = inferotemporal.

Appendix 1.

Questionnaire about pain occurred after intravitreal injection. ST = superotemporal; IT = inferotemporal; SN = superonasal.

Table 1.

Comparison of pain after intravitreal injection

	Mean pain (SD)	p-value
Age
≥65 year	3.13 (1.81)	0.008^*
<65 year	2.35 (1.79)
Sex
Male	2.73 (1.85)	0.272^*
Female	3.04 (1.82)
Past history
Diabetes mellitus (+)	2.17 (1.45)	0.011^*
Diabetes mellitus (−)	3.05 (1.88)
Drug
Bebacizumab	2.66 (1.70)	0.607^†
Aflibercept	2.95 (1.96)
Ranibizumab	3.09 (1.86)
Dexamethasone	3.60 (2.70)
Injection site
Superotemporal	3.20 (1.78)	0.012^†
Superonasal	3.03 (1.79)
Inferotemporal	2.35 (1.86)
Right	2.80 (1.96)	0.607^*
Left	2.94 (1.71)
Upper	3.16 (1.80)	0.002^*
Lower	2.25 (1.77)

SD = standard deviation.

^* Student t-test

^† Kruskal-Wallis test.

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