van Asten Freekje, van Middendorp Henriët, Verkerk Samuël, Breukink Myrte B, Lomme Roger M L M, Hoyng Carel B, Evers Andrea W, Klevering B Jeroen
*Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands; †Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, the Netherlands; and Departments of ‡Medical Psychology, and §Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.
Retina. 2015 Sep;35(9):1778-85. doi: 10.1097/IAE.0000000000000550.
This study investigated whether pain from intravitreal injections (IVIs) can be reduced by injecting with a 33-G needle instead of the commonly used 30-G needle. Additionally, several pain-related psychological factors were explored as predictors of outcome.
This randomized crossover trial included 36 patients who received injections with both needles in randomized order. After the injection, patients rated IVI pain on a 0 to 10 scale. Before injection, distress and pain expectations were assessed. Afterward, patients rated the IVI procedure and anticipated consequences. In addition, we assessed the force necessary to penetrate the sclera for both needles in porcine eyes.
The 33-G needle did not result in lower IVI pain (2.8 vs. 3.1, P = 0.758) but tended to cause less vitreal reflux (0 vs. 5 times, P = 0.054). Factors related to more pain were distress, expecting IVI pain and discomfort, dissatisfaction with the preparation procedure, anticipating negative consequences, and female gender. Patients regarded povidone-iodine disinfection as particularly unpleasant. Exploration of the needles' mechanical properties showed that 33-G needles penetrate the sclera more easily.
The thinner 33-G needle does not reduce IVI pain but may limit scleral damage. Future efforts could be aimed at optimizing patient information, reducing distress, and the use of better tolerable disinfectants.
本研究调查了使用33G针头而非常用的30G针头进行玻璃体内注射（IVI）是否能减轻疼痛。此外，还探讨了几种与疼痛相关的心理因素作为结果的预测指标。
这项随机交叉试验纳入了36例患者，他们按随机顺序接受两种针头的注射。注射后，患者用0至10分对IVI疼痛进行评分。注射前，评估患者的痛苦程度和疼痛预期。之后，患者对IVI操作和预期后果进行评分。此外，我们评估了两种针头在猪眼中穿透巩膜所需的力量。
33G针头并未使IVI疼痛减轻（2.8分对3.1分，P = 0.758），但玻璃体反流倾向较少（0次对5次，P = 0.054）。与更多疼痛相关的因素包括痛苦、预期IVI疼痛和不适、对准备过程不满意、预期负面后果以及女性性别。患者认为聚维酮碘消毒特别令人不适。对针头机械性能的研究表明，33G针头更容易穿透巩膜。
更细的33G针头并不能减轻IVI疼痛，但可能会限制巩膜损伤。未来的努力可以旨在优化患者信息、减轻痛苦以及使用耐受性更好的消毒剂。
