Versorgung von Patienten mit Makulaödem in der Göttinger Augenklinik: Vergleich zweier intravitrealer Applikationsformen hinsichtlich Akzeptanz und Verträglichkeit

Comparison of two intravitreal forms of administration with regard to acceptance and tolerability

by Negin Pakravesh
Doctoral thesis
Date of Examination:2017-11-21
Date of issue:2017-11-16
Advisor:Prof. Dr. Nicolas Feltgen
Referee:Prof. Dr. Rainer Laskawi
Referee:Prof. Dr. Martin Oppermann
Persistent Address: http://dx.doi.org/10.53846/goediss-6587

 

 

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Abstract

English

Purpose: Intravitreal drug injection is typically performed with 30 gauge cannulas using liquid or gas, while the 22 gauge applicator is used in dexamethasone implantation. The aim of the study was to compare patient information on the acceptance and tolerability of both forms of application. Method: Monocentric, two-armed, open, prospective patient survey before and 3 months after intravitreal injection. Patients with macular edema requiring treatment were enrolled for the first time or started recently (up to now 2 injections). In addition to the pre- and postoperative visual acuity, the substance used, the number of injections and the ophthalmological controls were also recorded. Pain before and after surgery (scale 1-10) was also asked, as well as intraoperative pain when rinsing the conjunctiva with a disinfectant and the injection itself (scale 1-10). The scales were each defined so that the larger number means a more pronounced expression. Topical anesthesia was standardized (5 drops at 5 min intervals). The statistical evaluation was done with the Chi-square or Fisher's exact test (binary) and the Wilcoxon-Mann-Whitney test (scores). Results: 37 patients had a 30 gauge injection (Group I), 16 of whom had the first, 10 the second and 11 the third. Twenty-four patients underwent a 22-gauge implantation (group II), 21 of them the first and 3 the second injection. The median number of postoperative ophthalmologic visits was 6 in Group I and 3 in 3 months in Group II (p = 0.0011). Preoperative pain did not exist in any patient. Intraoperative pain from conjunctival disinfection was perceived differently, averaging 3.0 in group I and 0 in group II (p <0.0001), and the median injection pain was 2 in both groups (p = 0.2936). Postoperative pain was reported in group I as 2 (median) and in group II as 3 (p = 0.6652). All patients from group 1 and 22 patients (92%) from group 2 stated that they wanted to repeat the procedure if necessary (p = 0.1508). Conclusion: Both forms of administration were well tolerated and showed no difference in the painfulness of standardized topical anesthetics. After a dexamethasone implantation, patients presented less frequently to the ophthalmologist
Keywords: Comparison of two intravitreal forms of administration with regard to acceptance and tolerability
Schlagwörter: Makulaödem
 
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