Evaluation of patients’ experiences at different stages of the intravitreal injection procedure – what can be improved? (original) (raw)
Related papers
Clinical Ophthalmology, 2011
Introduction: Intravitreal injection of ranibizumab has become one of the most commonly performed ophthalmic procedures. It is timely to conduct an evaluation of the injection procedure from the patient's perspective so as to determine ways to improve patient experience. The purpose of this study was to quantitatively describe patients' experiences of the different stages of the intravitreal injection procedure and provide suggestions for improvement. Method: Following intravitreal injection, patients were administered a questionnaire to score the distress felt for each of ten parts of the whole injection process from the initial waiting to the final instillation of topical antibiotic at the end. A score of higher than 4 was regarded as significantly unpleasant. The proportion of scores above 4 for each step was used to evaluate the relative distress experienced by patients for the different parts of the procedure. Results: A total of 42 patients were surveyed. The step with the highest percentage of patients scoring more than 4 was the injection step (19%). However, cumulatively, the steps relating to the application of the drape, the speculum, and the removal of drape accounted for 53% of scores greater than 4. Conclusion: There is considerable variation in how patients tolerate different stages of the injection procedure. The needle entry was the most unpleasant step followed by the draping steps cumulatively. Use of subconjunctival anesthesia, a perforated drape, and alternative lid exclusion devices may help to improve the patient's tolerability of the procedure and experience.
Patient Pain during Intravitreal Injection under Modified Topical Anesthesia -A Comparative Study
https://www.ijrrjournal.com/IJRR\_Vol.7\_Issue.10\_Oct2020/Abstract\_IJRR0034.html, 2020
Purpose: To compare the pain experienced by the patients during intravitreal injection under two different techniques of topical anesthesia. Materials and Methods: Total ninety-four, treatment-naive, female patients, receiving intravitreal injections (Ranibizumab/ Bevacizumab) were included in this prospective study. They were randomized to either of the techniques of anesthesia. Group A (n=47) 0.5% proparacaine eye drops. Group B (n=47) 0.5% proparacaine eye drops plus proparacaine-soaked cotton bud. Immediately after the injection, each patient was given a visual analog scale (VAS) to rate their pain experienced during the injection between 0 (no pain) and 10 (worst-pain, unbearable). Results: Mean VAS pain score was 2.32 ±2.20 in group A and 2.11 ±3.42 in group B, with no statistically significant difference (p = 0.170) between the two groups. Surgeon satisfaction was significantly better in Group B (7.06 ±0.89 in Group A and 8.58 ±0.62 in Group B, p=0.04). Conclusion: Although there was no significant difference in VAS pain scores between the groups but surgeon satisfaction was significantly higher in group B using proparacaine soaked cotton bud at the injection site in addition to proparacaine eye drops.
2018
OBJECTIVE: To compare level of comfort of patients in terms of pain and conjunctival congestion in intravitreal injection of Avastin (Bevacizumab) between old technique (OT) using speculum for lid retraction and modified technique (MT) with the use of bimanual assistance for lid retraction. METHOD: Prospective analytical study. Fifty participants were enrolled in the study. A questionnaire for subjective assessment of patients’ comfort in terms of pain and objective assessment of conjunctival congestion was filled according to a predefined congestion scale immediately after intravitreal injections. Patients were followed up for 4 weeks. RESULTS: Fifty patients were included in this study who were given intravitreal injection Avastin using speculum (OT) and bimanual assistance (MT), 25 with each technique. Our study showed that patients’ comfort was much more for modified technique than old technique in terms of pain and congestion. Average pain and congestion score in MT was 2.88±1....
Purpose: To compare the anesthetic effectiveness of topical proparacaine drops, subconjunctival lidocaine, and 2% lidocaine gel. Methods: Ninety-two patients undergoing intravitreal injections were randomi- zed to 1 of 3 groups: proparacaine 0.5% drops (Group Drops), proparacaine 0.5% drops plus subconjunctival lidocaine (Group SC), or 2% lidocaine gel (Group Gel). Patients were asked to score their pain experience using a visual analog scale of 0 to 10 immediately following the injections and 10 min, 1 h, 6 h, and 24 h after the injections. Patients also graded the overall injection experience as Excellent, Very Good, Fair, Poor, or Awful. The physician evaluated the patients’ eye movement during intravitreal injection on 3 levels: (0) none or minimal, (1) not compromising the injection, and (2) compromising the injection. Results: The patients in Group Drops had the worst mean pain scores during the injection and 10 min after, with the highest occurrence of movements com- promising the procedure (Grade 2; 38.7%). The patients in Group SC had a higher percentage of good experiences (37.9%) but a higher incidence of chemosis (16.7%). The patients in Group Gel had similar overall pain scores to Group Drops patients but a higher incidence of keratitis (19.4%). There was no statistically significant correlation between the use of aspirin or anticoagulants and the occurrence of hyperemia or hyposphagma. Conclusions: Subconjunctival lidocaine was most effective in preventing pain and eye movements during intravitreal injections. Although 2% lidocaine gel produced a good overall experience for the patients, the incidence of keratitis was very high (19.4%). Therefore, we do not recommend 2% lidocaine gel as the first anesthetic choice for intravitreal injections. There is no evidence to suspend the use of aspirin or other anticoagulants drugs prior to intravitreal injections.
Arquivos brasileiros de oftalmologia
Purpose: To evaluate and describe the precautions involved in the technique of intravitreal injection of antiangiogenic drugs adopted by the ophthalmologists who are members of the Brazilian Society of Retina and Vitreous (SBRV). Methods: A questionnaire containing 22 questions related to precautions taken before, during, and after intravitreal injection was sent electronically to 920 members of SBRV between November 15, 2013 and April 31, 2014. Results: 352 responses (38%) were obtained. There was a predominance of men (76%) from the southwest region of Brazil (51%). The professional experience varied between 6 and 15 years after medical specialization (50%). Most professionals (76%) performed an average of 1 to 10 intravitreal injections a week, and 88% of the procedures were performed in the operating room using povidone iodine (99%), sterile gloves, and blepharostat (94%). For inducing topical anesthesia, usage of anesthetic eye drops was the most used technique (65%). Ranibizum...
Patient pain during intravitreal injections under topical anesthesia: a systematic review
International journal of retina and vitreous, 2017
Intravitreal injection (IVI) is a very common vitreoretinal procedure, and multiple injections are often required per patient. This systematic review was conducted to evaluate the effectiveness of various local anesthetic techniques in reducing pain during injection. A systematic review was conducted based on searches of Cochrane, LILACS, PubMed, Scopus, Web of Science, and the gray literature (Google Scholar). The end search date was February 19, 2016, across all databases. We classified pain by converting visual analog scale (VAS) scores (0-100 mm) into Jensen's classification levels: 0-4, no pain; 5-44, mild pain; 45-74, moderate pain; and 75-100, severe pain. An intervention was considered clinically significant when pain score change was >12 mm on a 100-mm scale. Eight studies out of 23 met the eligibility criteria. The total number of patients was 847. Most studies (5/8 [62.5%]) were at unclear risk of bias because of unclear randomization, thus providing only moderate ...
Ophthalmology and therapy, 2016
Many ocular diseases require intravitreal injections of pharmacological agents. Optimizing patients' experiences during injections is important to ensure compliance and maintenance of quality of life. The objective of this study was to identify strategies to help alleviate discomfort during intravitreal injections. A cross-sectional study surveying 128 patients during clinic visits between 2014 and 2015 in two outpatient Retina Clinics (one academic and one private). Patients receiving an intravitreal injection(s) for any retinal disorder were given a questionnaire with 10-yes/no responses for various potential strategies. Responses were stratified by sex, age (<30 years, 30-60 years, and >60 years) and total number of prior injections (0-9 injections, 10-20 injections and >20 injections). A total of 128 patients were surveyed: 59 males, 41 females and 28 with no sex specified. Our results identified four favorable strategies as those receiving more than 50% "yes&q...
Ocular Pain After Intravitreal Injection*
Current Eye Research, 2013
Purpose: To evaluate the efficacy of different anesthetics and topical anti-inflammatory treatment in patients undergoing intravitreal injections (IVI). Methods: Prospective, randomized, double masked, comparative study. Patients undergoing 0.05 mL IVI were randomized to two different preoperative anesthetic regimes (regime A [0.5% tetracaine þ naphazoline] versus regime B [5% lidocaine]) and two different post-injection topical protocols (protocol 1 [tobramycin qid] versus protocol 2 [tobramycin qid þ diclofenac qid]). Patients were trained to score pain using a numerical rating pain scale from 0 (no pain) to 10 (excruciating pain) immediately after the injection, 30 min and 24 h later. Patients were instructed to take oral paracetamol (650-1000 mg, adjusted to the patient's weight) every six hours ad lib if necessary.
The Impact of Prefilled Syringes on Endophthalmitis following Intravitreal Injection of Ranibizumab
American Journal of Ophthalmology
PURPOSE: To compare the rates of infectious endophthalmitis following intravitreal injection of ranibizumab using prefilled syringes vs conventional preparation. DESIGN: Multicenter retrospective cohort study. METHODS: All eyes receiving intravitreal injection of 0.5 mg ranibizumab for retinal vascular diseases at 10 retina practices across the United States (2016 to 2017) and Japan (2009 to 2017) were included. The total numbers of eyes and injections were determined from billing codes. Endophthalmitis cases were determined from billing records and evaluated with chart review. Primary outcome was the rate of postinjection acute endophthalmitis. Secondary outcomes were visual acuity and microbial spectrum. RESULTS: A total of 243 754 intravitreal 0.5 mg ranibizumab injections (165 347 conventional and 78 407 prefilled) were administered to 43 132 unique patients during the study period. In the conventional ranibizumab group, a total of 43 cases of suspected endophthalmitis occurred (0.026%; 1 in 3845 injections) and 22 cases of culture-positive endophthalmitis occurred
Intravitreal Injection Guidelines
2015
With an increase in the number of intravitreal injections especially intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents the risk for endophthalmitis is a potential concern. A meta-analysis by Jager et al. shows that the prevalence of endophthalmitis following intravitreal injections is low. They evaluated the incidence of endophthalmitis into infectious and non-infectious categories and found that the endophthalmitis rate was 0.9% (38/4382) per eye and 0.3% (38/14 866) per injection, when looking at both infectious and non-infectious cases. They also found endophthalmitis rate of 1.4% per injection for intravitreal triamcinolone acetonide and 0.2% per injection for intravitreal ranibizumab. The risk of endophthalmitis after intravitreal injection may vary with various drugs. The reported incidence of endophthalmitis per patient in multicenter clinical trials with anti-vascular endothelial growth factor (VEGF) therapy ranged from 0.019 to 1.6%. Although cases of ...