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Quadrant-Specific Pain in Intravitreal Injection: A Systematic Review and Meta-analysis.

Mehmet Cem Sabaner1, Irem Gunes2,3, Abdullah Divarci2

  • 1Department of Ophthalmology, Bilecik Training and Research Hospital, Bilecik, Turkey. drmcemsabaner@yahoo.com.

Ophthalmology and Therapy
|March 13, 2026
PubMed
Summary
This summary is machine-generated.

This study found no significant difference in patient-reported pain between intravitreal injection (IVI) quadrants. Pain management for IVI should focus on anesthesia and technique, not injection site.

Keywords:
Intravitreal injectionMeta-analysisPainQuadrantsSystematic reviewVisual analogue scale

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Area of Science:

  • Ophthalmology
  • Pain Management
  • Retinal Diseases

Background:

  • Patient-reported pain during intravitreal injections (IVI) can impact treatment adherence.
  • Understanding pain variations by injection quadrant is crucial for optimizing patient comfort.

Purpose of the Study:

  • To determine if patient-reported pain differs significantly across the four main intravitreal injection quadrants.
  • To identify the least painful quadrant for IVI procedures.

Main Methods:

  • A systematic literature search was conducted across 13 databases for studies reporting IVI pain by quadrant.
  • Random-effects meta-analyses were used to compare pain scores (0-10 VAS) across all six pairwise quadrant contrasts.
  • Seven studies involving 2048 IVI were included in the qualitative review and meta-analysis.

Main Results:

  • Pooled mean differences in pain between injection quadrants were small (<1 VAS unit) and not statistically significant, with confidence intervals crossing zero.
  • Substantial heterogeneity (I² > 80%) was observed across studies, indicating inconsistent findings.
  • No specific quadrant consistently demonstrated less reported pain.

Conclusions:

  • Current evidence does not support a specific quadrant being less painful for intravitreal injections.
  • Significant heterogeneity limits definitive conclusions on quadrant-specific pain.
  • Future research should standardize pain assessment and quadrant allocation to investigate potential subtle differences.