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Purpose: To compare reflux, intraocular pressure (IOP) variation and pain following intravitreal (IV) injections using 30-gauge and 32-gauge needles in patients with retinal pathologies in Saudi Arabia.  Methods: A double-blind randomized clinical trial was conducted in 2018. Participants were randomized to receive IV injections of Ranibizumab using 30-gauge (Gr 1 ) or 32-gauge (Gr 2 ) needles. The amount of reflux of injected material, IOP before (IOP 1 ) and five minutes after injection (IOP 2 ) were measured. The patient-perceived pain score was assessed using a visual analogue score (VAS). Outcome variables were compared.  Results: The study sample was comprised of 86 eyes (86 patients) in each group. Gender (P=0.76), laterality (P=0.55) and age (P=1.0) were not different between groups. The reflux in Gr 1  [34.9% (95% confidence interval {CI}, 24.8; 45.0)] was significantly higher compared to Gr 2  [22.1% (95% CI, 13.3; 30.9)] (P=0.007). The median pain score was 1 in both Gr 1  [interquartile range (IQR) 1.0: 3.0] and Gr 2  (IQR 0.0; 2.0) (P=0.04). Among 56 eyes without reflux in Gr 1 , the IOP 1  and IOP 2  were 13.6±2.7 mmHg and 16.4±5.0 mmHg, respectively. Among 67 eyes without reflux in Gr 2 , the IOP 1  and IOP2 were 13.6±2.9 mmHg and 17.0±5.2 mmHg, respectively. The change in percentage in IOP in Gr 1  and Gr 2  was not significantly different (Mann Whiney P=0.3).  Conclusions: IV injection given by 30-gauge needle compared to 32-gauge needle resulted in greater patient-perceived pain and more reflux of injected material from the injection site. An increase in IOP was not associated with the gauge of the needle used for IV injection.

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Reflux, Intraocular Pressure Variation and Pain Following Intravitreal Ranibizumab Injections Using 30-Gauge or 32-Gauge Needles for Patients With Retinal Pathologies: A Randomized Clinical Trial