title: Needle size in intravitreal injections - pain evaluation of a randomized clinical trial.
abstract: OBJECTIVE
  To evaluate the influence of the needle size used for intravitreal (IVT) injections on patients' pain experience in a randomized, double-armed, single-blinded, clinical trial.
  
  
  METHODS
  Patients included were randomized to have an IVT injection performed with a 27-gauge needle (group 1) or with a 30-gauge needle (group 2). The topical anaesthesia before the injection was standardized. Immediately after the injection, patients were asked to grade their pain using the visual analogue scale (VAS) and the Wong-Baker FACES scale. The main outcome measure was the pain score assessment. Cofactors analysed were patients' demographics (age and gender) and clinical characteristics (such as the number of previous IVT injections). In addition, scaled surgeon's questionnaires to assess the IVT injection procedure were evaluated. For statistical analysis, a regression model was used.
  
  
  RESULTS
  The data of 208 patients (group 1: 104 patients; group 2: 104 patients) were analysed. There was no significant difference in the VAS pain scores (p > 0.18) and in the Wong-Baker pain scores (p > 0.59) between both treatment groups. Gender (p = 0.0288) and the number of previous IVT injections (p = 0.0028) significantly influenced the VAS pain scores (p < 0.05). Female patients and patients with a history of previous IVT injections had higher pain scores. The surgeon's questionnaire showed an overall preference towards the use of a 30-gauge needle for IVT injections.
  
  
  CONCLUSIONS
  The use of a 30-gauge needle for IVT injections showed no significant effect in pain relief compared to the use of a 27-gauge needle. However, a 30-gauge needle was preferred by all surgeons.
authors.affiliation: Department of Ophthalmology, Rudolf Foundation Clinic, Vienna, Austria.
authors.forename: Paulina
authors.initials: P
authors.lastname: Haas
authors.affiliation: Department of Ophthalmology, Rudolf Foundation Clinic, Vienna, Austria.
authors.forename: Christiane
authors.initials: C
authors.lastname: Falkner-Radler
authors.affiliation: Department of Ophthalmology, Rudolf Foundation Clinic, Vienna, Austria.
authors.forename: Barbara
authors.initials: B
authors.lastname: Wimpissinger
authors.affiliation: Section for Medical Statistics, CeMSIIS, Medical University of Vienna, Vienna, Austria.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Malina
authors.affiliation: Department of Ophthalmology, Rudolf Foundation Clinic, Vienna, Austria.
authors.forename: Susanne
authors.initials: S
authors.lastname: Binder
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058447:Eye Pain / Q000175:diagnosis*; D005260:Female; D006801:Humans; D058449:Intravitreal Injections / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D009339:Needles; D010147:Pain Measurement; D011594:Psychometrics; D016037:Single-Blind Method; D011795:Surveys and Questionnaires
keywords: VAS; Wong-Baker; age-related macular degeneration; intravitreal injection; pain score