School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK.
Ophthalmology, Cardiff and Vale University Health Board, Cardiff, UK.
BMJ Open. 2023 Aug 16;13(8):e069625. doi: 10.1136/bmjopen-2022-069625.
Ocular pain is a commonly reported finding in the intravitreal injection procedure, but post-injection experiences and patient adherence to treatment remain underexplored. We therefore aimed to identify key variations in the intravitreal injection procedure that may influence pain, and to gain insights into the post-injection experience and treatment adherence from the perspective of patients and practitioners.
Qualitative semistructured interview study using reflexive thematic analysis of transcripts.
Hospital Eye Clinic in Wales, UK. Interviews were conducted between May and September 2019.
Purposive sample of patients aged ≥50 years with neovascular age-related macular degeneration and no other retinal pathology who had received at least six intravitreal injections, and practitioners including ophthalmologists, registered nurses and optometrists who performed intravitreal injections at the research site.
Data saturation was reached with 21 interviews: 14 patients and 7 practitioners. Three main themes were identified from the analysis: fear of losing eyesight and treatment anxiety influence patient adherence to treatment, variability in pain experience during treatment, and post-injection experience and impact on patient recovery. To reassure patients feeling apprehensive about the injections, practitioners promoted safety and trust, and used techniques to manage anxiety. Key variations that may influence pain identified were application of antiseptic or anaesthetic, injecting methods and communication. During injection, patients reported a dull-aching and sharp pain, contrary to practitioners' perspective of feeling a 'pressure'. Patients described prolonged soreness and irritation of up to 36 hours post-injection affecting their sleep and recovery.
Establishing rapport supported patients to recognise the necessity of ongoing treatment to prevent sight loss; however, inadequate pain management led to undesirable outcomes. Practitioners should use pain assessment tools during and immediately after injection and provide ongoing consistent information to help patients manage pain at home.
眼部疼痛是玻璃体内注射过程中常见的报告发现，但注射后的体验和患者对治疗的依从性仍未得到充分探索。因此，我们旨在确定可能影响疼痛的玻璃体内注射程序的关键差异，并从患者和从业者的角度了解注射后的体验和治疗依从性。
使用对记录的反思性主题分析进行定性半结构化访谈研究。
英国威尔士的医院眼科诊所。访谈于 2019 年 5 月至 9 月进行。
纳入至少接受过 6 次玻璃体内注射且年龄≥50 岁的患有新生血管性年龄相关性黄斑变性且无其他视网膜病变的患者，以及在研究现场进行玻璃体内注射的从业者，包括眼科医生、注册护士和验光师。
对 21 次访谈进行数据分析后达到数据饱和：14 名患者和 7 名从业者。分析确定了三个主要主题：对失明和治疗焦虑的恐惧影响患者对治疗的依从性、治疗过程中疼痛体验的变异性，以及注射后的体验和对患者康复的影响。为了缓解对注射感到不安的患者的焦虑，从业者促进了安全性和信任，并使用了一些技术来管理焦虑。确定的可能影响疼痛的关键差异包括使用消毒剂或麻醉剂、注射方法和沟通。在注射过程中，患者报告了一种隐痛和刺痛，与从业者感觉“压力”的观点相反。患者描述了注射后长达 36 小时的持续性疼痛和刺激，这影响了他们的睡眠和康复。
建立融洽关系有助于患者认识到持续治疗以防止视力丧失的必要性；然而，疼痛管理不足导致了不理想的结果。从业者应在注射过程中和注射后立即使用疼痛评估工具，并提供持续一致的信息，帮助患者在家中管理疼痛。
