Ocular pain after intravitreal injection.

Area of Science:

• Ophthalmology
• Anesthesiology
• Pharmacology

Background:

• Intravitreal injections (IVI) are common ophthalmic procedures.
• Effective pain management and prevention of post-injection complications are crucial for patient comfort and outcomes.

Purpose of the Study:

• To compare the efficacy of two anesthetic regimens (tetracaine/naphazoline vs. lidocaine) prior to IVI.
• To evaluate the effectiveness of two post-injection topical protocols (tobramycin vs. tobramycin/diclofenac) in managing pain and inflammation.

Main Methods:

• A prospective, randomized, double-masked, comparative study involving 156 patients undergoing IVI.
• Patients received either tetracaine/naphazoline or lidocaine pre-injection.
• Post-injection, patients used either tobramycin or tobramycin with diclofenac, with pain assessed using a numerical rating scale.

Main Results:

• No significant difference in pain scores was observed between tetracaine/naphazoline and lidocaine immediately after IVI (p=0.73).
• Topical diclofenac did not lead to a significant reduction in pain scores 24 hours post-injection compared to tobramycin alone (p=0.46).
• Conjunctival hemorrhage was less frequent with topical naphazoline (p=0.055).

Conclusions:

• Both topical tetracaine and lidocaine provide similar anesthesia for IVI.
• Topical diclofenac does not appear to offer additional pain relief after intravitreal injections.
• Naphazoline may help reduce conjunctival hemorrhage post-injection.