title: Assessment of patient pain experience during intravitreal 27-gauge bevacizumab and 30-gauge ranibizumab injection.
abstract: OBJECTIVE
  To compare pain scores of patients during intravitreal 27-gauge bevacizumab and 30-gauge ranibizumab injection procedures.
  
  
  METHODS
  Seventy eyes of 70 patients who had not previously undergone intravitreal anti-vascular endothelial growth factor therapy were included in this study. Thirty-five patients received ranibizumab and 35 patients received bevacizumab. The diagnoses of the patients were: 27 age related macular degeneration, 15 diabetic macular edema, 9 diabetic vitreous hemorrhage, 6 central retinal vein occlusion, 11 branch retinal vein occlusion and 2 central serous chorioretinopathy. Bevacizumab (1.25 mg/0.05 mL) was injected into the vitreous cavity using a 27-gauge needle, and ranibizumab (0.5 mg/0.05 mL) was injected with 30-gauge needle. Patients were asked just after the injection to rate their perceived pain during the injection using the visual analogue scale (VAS) of 0 (no pain) to 10 (unbearable/worst pain). The average of these scores was used as the primary outcome.
  
  
  RESULTS
  The VAS pain scores in the ranibizumab and bevacizumab groups were 1.06 ± 0.91 (range, 0 to 3) and 1.94 ± 1.55 (range, 0 to 7), respectively, a significant difference (p = 0.005). Patients <65 and ≥65 years of age in both the ranibizumab and bevacizumab groups were then compared. For patients <65, there was a significant difference in the average VAS pain scores between groups (p = 0.003). However, for patients ≥65 years, there was not a significant difference in the average VAS pain scores between groups (p = 0.238). Female and male patients in both ranibizumab and bevacizumab groups were also compared. For female patients, there was a significant difference in the average VAS pain scores between groups (p = 0.016), although not for male patients (p = 0.078).
  
  
  CONCLUSIONS
  Thirty-gauge intravitreal injection is more comfortable than 27-gauge injection. Injection of bevacizumab with 30-gauge needle syringes may be more tolerable for patients.
authors.affiliation: Department of Ophthalmology, Adıyaman University School of Medicine, Adiyaman, Turkey.
authors.forename: Mete
authors.initials: M
authors.lastname: Güler
authors.affiliation: Department of Ophthalmology, Adıyaman University Education and Research Hospital, Adiyaman, Turkey.
authors.forename: Burak
authors.initials: B
authors.lastname: Bilgin
authors.affiliation: Department of Ophthalmology, Adıyaman University School of Medicine, Adiyaman, Turkey.
authors.forename: Musa
authors.initials: M
authors.lastname: Çapkın
authors.affiliation: Department of Ophthalmology, Adıyaman University School of Medicine, Adiyaman, Turkey.
authors.forename: Ali
authors.initials: A
authors.lastname: Şimşek
authors.affiliation: Department of Ophthalmology, Adıyaman University School of Medicine, Adiyaman, Turkey.
authors.forename: Şemsettin
authors.initials: Ş
authors.lastname: Bilak
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage*; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage*; D000068258:Bevacizumab / Q000008:administration & dosage*; D003930:Diabetic Retinopathy / Q000188:drug therapy / Q000503:physiopathology; D005260:Female; D006801:Humans; D058449:Intravitreal Injections; D008268:Macular Degeneration / Q000188:drug therapy / Q000503:physiopathology; D008269:Macular Edema / Q000188:drug therapy / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D000069579:Ranibizumab / Q000008:administration & dosage*; D012170:Retinal Vein Occlusion / Q000188:drug therapy / Q000503:physiopathology
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D000069579:Ranibizumab
keywords: Bevacizumab; Intravitreal injections; Pain; Ranibizumab; Visual analogue scale