TY - JOUR
T1 - Effect of Needle Gauge Size on Pain During Intravitreal Anti-VEGF Injection
T2 - A Systematic Review and Network Meta-Analysis
AU - Butler, Emilie T.S.
AU - Bjerager, Jakob
AU - Eriksen, Nathalie S.
AU - Hajari, Javad N.
AU - Schneider, Miklos
AU - Faber, Carsten
AU - Subhi, Yousif
PY - 2024/3
Y1 - 2024/3
N2 - Introduction: Concerns related to pain from intravitreal injections are one of the key factors mentioned by patients when asked about therapy. In this systematic review and network meta-analysis, we evaluate the literature of comparative clinical trials on the relationship between needle gauge size and pain experience during intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy. Methods: We searched 12 literature databases on 14 October 2023 for comparative studies of gauge sizes for intravitreal anti-VEGF injections. The primary outcome of interest was the reported pain experience immediately after the injection. All outcomes of pain were transformed into standardized effect sizes using Cohen’s d. Using a network meta-analysis approach, we were able to compare all gauge sizes and rank them according to the reported pain experience. Results: We identified nine eligible studies with data on a total of 998 patients and 1004 eyes. Needle sizes studied were 26-gauge, 27-gauge, 29-gauge, 30-gauge, 32-gauge, 33-gauge, and 34-gauge. A complete network was present, which allowed for a network meta-analysis. We used the thickest (26-gauge) needle as the reference group and observed a clear trend of lower pain experience with thinner gauge sizes (d: −0.4, d: −2.7, d: −3.8, d: −4.8, d: −4.5, and d: −5.3; respectively, for 27-gauge, 29-gauge, 30-gauge, 32-gauge, 33-gauge, and 34-gauge). Conclusion: A gauge size of 30 or thinner may minimize patient discomfort related to intravitreal anti-VEGF therapy.
AB - Introduction: Concerns related to pain from intravitreal injections are one of the key factors mentioned by patients when asked about therapy. In this systematic review and network meta-analysis, we evaluate the literature of comparative clinical trials on the relationship between needle gauge size and pain experience during intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy. Methods: We searched 12 literature databases on 14 October 2023 for comparative studies of gauge sizes for intravitreal anti-VEGF injections. The primary outcome of interest was the reported pain experience immediately after the injection. All outcomes of pain were transformed into standardized effect sizes using Cohen’s d. Using a network meta-analysis approach, we were able to compare all gauge sizes and rank them according to the reported pain experience. Results: We identified nine eligible studies with data on a total of 998 patients and 1004 eyes. Needle sizes studied were 26-gauge, 27-gauge, 29-gauge, 30-gauge, 32-gauge, 33-gauge, and 34-gauge. A complete network was present, which allowed for a network meta-analysis. We used the thickest (26-gauge) needle as the reference group and observed a clear trend of lower pain experience with thinner gauge sizes (d: −0.4, d: −2.7, d: −3.8, d: −4.8, d: −4.5, and d: −5.3; respectively, for 27-gauge, 29-gauge, 30-gauge, 32-gauge, 33-gauge, and 34-gauge). Conclusion: A gauge size of 30 or thinner may minimize patient discomfort related to intravitreal anti-VEGF therapy.
KW - Anti-VEGF
KW - Intravitreal injection
KW - Network meta-analysis
KW - Pain
KW - Systematic review
U2 - 10.1007/s40123-023-00879-7
DO - 10.1007/s40123-023-00879-7
M3 - Journal article
C2 - 38265622
AN - SCOPUS:85182986673
SN - 2193-8245
VL - 13
SP - 801
EP - 817
JO - Ophthalmology and Therapy
JF - Ophthalmology and Therapy
IS - 3
ER -