ASSOCIATION BETWEEN NEEDLE SIZE, POSTINJECTION REFLUX, AND INTRAOCULAR PRESSURE SPIKES AFTER INTRAVITREAL INJECTIONS

Retina. 2015 Jul;35(7):1401-6. doi: 10.1097/IAE.0000000000000476.

Abstract

Purpose: To compare the effect of 30-gauge versus 32-gauge needle size on postinjection reflux and immediate postinjection intraocular pressure (IOP(immed_post)) spikes in eyes injected with anti-vascular endothelial growth factor agents.

Methods: This was a prospective interventional case series of 65 eyes of 54 consecutive patients in a clinical practice setting who received intravitreal anti-vascular endothelial growth factor therapy. All eyes had preinjection IOP, IOP(immed_post), postinjection reflux, and axial lengths recorded.

Results: There was a higher incidence of postinjection reflux in eyes injected with 30-gauge (53%) compared with those injected with 32-gauge (13%, P = 0.0007). Among 34 eyes injected with 30-gauge, 16 eyes without appreciable postinjection reflux had mean IOP(immed_post) of 44.3 ± 7.48 mmHg and mean IOP(immed_post) elevation of 29.6 ± 2.10 mmHg, which was significantly higher than the 18 eyes with reflux (mean IOP(immed_post) of 18.8 ± 7.15 mmHg and mean IOP(immed_post) elevation of 4.5 ± 1.74 mmHg, P < 0.0001). Among 31 eyes injected with 32-gauge, 27 eyes without appreciable postinjection reflux had mean IOP(immed_post) of 44.4 ± 10.82 mmHg and mean IOP(immed_post) elevation of 29.5 ± 1.99 mmHg, which was significantly higher than the 4 eyes with reflux (mean IOP(immed_post) of 21.3 ± 8.54 mmHg and mean IOP(immed_post) elevation of 9.5 ± 4.05 mmHg, P < 0.001). The differences in reflux and IOP between the two groups were unrelated to axial lengths (P = 0.451).

Conclusion: Eyes receiving injections with 32-gauge needles had a lower incidence of postinjection reflux and higher mean IOP immediately after injection.

Publication types

  • Clinical Study
  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Angiogenesis Inhibitors / adverse effects*
  • Angiogenesis Inhibitors / therapeutic use
  • Diabetic Retinopathy / drug therapy
  • Diabetic Retinopathy / physiopathology
  • Female
  • Humans
  • Intraocular Pressure / drug effects*
  • Intraocular Pressure / physiology
  • Intravitreal Injections / adverse effects*
  • Macular Edema / drug therapy
  • Macular Edema / physiopathology
  • Male
  • Needles*
  • Postoperative Complications*
  • Prospective Studies
  • Ranibizumab / adverse effects
  • Ranibizumab / therapeutic use
  • Receptors, Vascular Endothelial Growth Factor / adverse effects
  • Receptors, Vascular Endothelial Growth Factor / therapeutic use
  • Recombinant Fusion Proteins / adverse effects
  • Recombinant Fusion Proteins / therapeutic use
  • Retinal Vein Occlusion / drug therapy
  • Retinal Vein Occlusion / physiopathology
  • Tonometry, Ocular
  • Vascular Endothelial Growth Factor A / antagonists & inhibitors
  • Wet Macular Degeneration / drug therapy
  • Wet Macular Degeneration / physiopathology

Substances

  • Angiogenesis Inhibitors
  • Recombinant Fusion Proteins
  • VEGFA protein, human
  • Vascular Endothelial Growth Factor A
  • aflibercept
  • Receptors, Vascular Endothelial Growth Factor
  • Ranibizumab