TOPICAL APRACLONIDINE REDUCES PAIN AFTER INTRAVITREAL INJECTIONS: A Double-Blind Randomized Controlled Trial

Area of Science:

• Ophthalmology
• Pharmacology

Background:

• Intravitreal injections (IViT) are common treatments for various ocular conditions.
• Pain and subconjunctival hemorrhage (SCH) are frequent side effects of IViT.
• Effective management of these side effects can improve patient compliance and experience.

Purpose of the Study:

• To assess the efficacy of topical apraclonidine in mitigating pain and SCH following IViT.
• To determine if apraclonidine offers a significant reduction in post-injection discomfort and bleeding.

Main Methods:

• A prospective, randomized, double-blinded crossover study involving 39 patients undergoing monthly IViT of bevacizumab.
• Patients received either topical apraclonidine 0.5% or placebo 30 minutes pre-injection, with treatments switched for the second injection.
• Pain was measured using the Numerical Rating Scale (NRS-11), and SCH size was assessed via slit lamp examination.

Main Results:

• Topical apraclonidine significantly reduced mean pain scores (1.69 vs. 3.28, P < 0.001).
• No significant difference in SCH incidence (41% vs. 51.3%, P = 0.503) or mean size (1.71 mm vs. 3.25 mm, P = 0.253) was observed in the overall cohort.
• A greater pain reduction was noted in phakic patients. Apraclonidine showed a smaller SCH reduction in patients with choroidal neovascularization or hypertension, but a greater reduction in phakic patients.

Conclusions:

• Topical apraclonidine 0.5% effectively decreases pain experienced during intravitreal injections.
• The medication did not significantly reduce the incidence or size of subconjunctival hemorrhage across all patients.
• Specific patient subgroups, such as phakic individuals, may experience additional benefits regarding SCH reduction.