Effect of Needle Gauge Size on Pain During Intravitreal Anti-VEGF Injection: A Systematic Review and Network Meta-Analysis
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 a...
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Published in | Ophthalmology and therapy Vol. 13; no. 3; pp. 801 - 817 |
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Main Authors | , , , , , , |
Format | Journal Article |
Language | English |
Published |
Cheshire
Springer Healthcare
01.03.2024
Adis, Springer Healthcare |
Subjects | |
Online Access | Get full text |
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Summary: | 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. |
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Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
ISSN: | 2193-8245 2193-6528 |
DOI: | 10.1007/s40123-023-00879-7 |