&lt;p&gt;Anesthesia for Intravitreal Injection: A Systematic Review&lt;/p&gt;

Han, Jonathan; Rinella, Nicholas; Chao, Daniel L.

doi:10.2147/opth.s223530

Cited by 14 publications

(13 citation statements)

References 25 publications

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“…These pain scores are in a similar range of pain scores reported from other prospective studies evaluating anesthetic agents during IVTs. 10 While this study was not powered to detect differences in pain scores between different cooling regimens, we did not observe any statistically significant difference of pain scores at the time of injection in pairwise comparisons between the three groups. It should also be noted that the sensitivity of this pain scale to detect small changes in pain perception is unknown.…”

Section: Discussionmentioning

confidence: 65%

Cooling Anesthesia for Intravitreal Injection: Results of the Prospective Open-Label, Dose-Ranging COOL-1 Trial

Chao¹,

Rinella²,

Khanani³

et al. 2021

OPTH

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Purpose To evaluate the safety and efficacy of a novel medical device to provide cooling anesthesia to the eye as local anesthesia for intravitreal injections. Study Design First in human, open-label study of 43 subjects assessed at three different doses: −10°C for 20 seconds (group 1), −15°C for 15 seconds (group 2), and −15°C for 20 seconds (group 3). Main outcome measures were safety and pain of injection using a numeric rating scale (NRS). Results Cooling anesthesia did not result in any serious ocular adverse events. One grade 1 adverse event was a vasovagal response during cooling administration which resolved immediately after cooling. Mean NRS scores at the time of injection for each group ranged from 2.5 to 4.3 There was a statistically significant difference between pain scores of the 3 groups at injection in aggregate but not in pairwise comparisons ( P value = 0.047). There was a statistically significant decrease in pain from injection to 5 minutes post injection in all groups ( P value = 0.00008, 0.003, 0.0005 for groups 1, 2, 3, respectively) as well as from 5 minutes to 24–48 hours ( P value = 0.00001, 0.018, and 0.0545 for groups 1, 2, 3, respectively). Conclusion The rapid cooling anesthesia device was well tolerated for achieving local anesthesia among patients receiving intravitreal injections with no serious ocular adverse events.

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Section: Discussionmentioning

confidence: 65%

Cooling Anesthesia for Intravitreal Injection: Results of the Prospective Open-Label, Dose-Ranging COOL-1 Trial

Chao¹,

Rinella²,

Khanani³

et al. 2021

OPTH

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“…A recent systematic review found no gold standard for anesthesia with respect to patient comfort during the intravitreal injection procedure [ 101 ]. A second systematic review of 847 patients in 8 studies described pain associated with intravitreal injections as “mild” (visual analog scale rating 5–44 mm).…”

Section: Resultsmentioning

confidence: 99%

Preventive factors, diagnosis, and management of injection-related endophthalmitis: a literature review

Singh

Davoudi

Ness

2022

Graefes Arch Clin Exp Ophthalmol

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Background Intravitreal medication injections represent the gold standard treatment for a variety of potentially blinding chorioretinal vascular diseases. Despite their excellent safety profile, they are associated with the feared complication of injection-related endophthalmitis (IRE). Though the overall incidence of IRE is low, due to the ever-increasing number of injections being performed, it is a complication that all retina specialists are likely to encounter. This article reviews various factors that could potentially influence the risk of IRE and discusses evidence-based strategies for management. Method PubMed was searched for keywords “intravitreal injection” and “endophthalmitis” from the period of 1995–2021. Relevant articles were reviewed and selected articles were analyzed with respect to the incidence, potential preventive factors, clinical presentation, microbial profile, management, and outcomes for IRE. Results There is strong consensus supporting the use of povidone iodine topical antiseptic, eyelid retraction away from the injection site, and avoiding treatment of eyes with active surface or eyelid disease, but there is less agreement on the use of face masks versus “no-talking” policies and optimal anesthetic technique. Current evidence comparing tap and inject or early vitrectomy for treatment of IRE is inadequate to determine an optimal treatment strategy. Conclusion Intravitreal injections are sight saving, but even using established prophylactic measures there remains a small but real risk of infectious injection-related complications. Further investigations comparing tap and inject versus vitrectomy may help to establish optimal treatment, although the rarity of IRE makes designing adequately powered prospective trials a difficult task.

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“…18 A survey of Canadian retina specialists showed that at least a quarter of them routinely used subconjunctival anaesthetics and up to half of them infrequently used the same. 19,20 Complications reported in the literature of intravitreal injections include raised intraocular pressure, uveitis and endophthalmitis. No patient in our study reported these complications.…”

Section: Discussionmentioning

confidence: 99%

Effect of Topical Versus Sub-conjunctival Anaesthesia during Administration of Intravitreal Bevacizumab Injection

Rizwan

Zafar

Asghar³

et al. 2021

pak J Ophthalmol

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Purpose: To compare the anesthetic effect of topical proparacaine hydrochloride 0.5% with sub-conjunctival lidocaine 2% for intravitreal injection of Bevacizumab. Study Design: Quasi experimental study. Place and Duration of Study: Department of Ophthalmology Fauji Foundation Hospital, Rawalpindi, from July 2017 to January 2018. Methods: Sixty 60 patients who needed intravitreal Bevacizumab were included in the study after approval from the ethical review board. Exclusion criteria were patients with conditions that could affect pain sensation, acute ocular inflammation, history of intravitreal injection, using systemic analgesic/sedatives, uncooperative patients and unable to understand the pain scale. Written informed consent was taken. Name, age, gender, diagnosis, previous intravitreal injection, hospital registration number, address and contact numbers were noted. Patients were briefed about the visual analogue scale. Patients were divided into two groups. Group A received proparacaine drops and group B was given subconjunctival lidocaine injections before intravitreal bevacizumab. Results: The mean age of patients in this study was 60.38 ± 10.55 years. There were 03 (5.0%) males and 57 (95.0%) females. Majority of the patients (30%) presented with choroidal neovascularization followed by diabetic maculopathy, vitreous hemorrhage, central retinal vein occlusion and proliferative diabetic retinopathy. Mean pain score among both the groups was 3.67 ± 1.97 (topical group) and 1.70 ± 1.51 (sub-conjunctival group) respectively which was statistically significant (p-value 0.000). Among age, diabetes, duration of diabetes and hypertension, only hypertension had moderate correlation with the pain score (correlation coefficient = 0.316, p values = 0.017). Conclusion: Sub-conjunctival anaesthesia results in less pain during intravitreal drug administration as compared to the topical anaesthesia. Key Words: Intravitreal injections, Bevacizumab, Intravitreal Anti-VEGF, Anesthesia.

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<p>Anesthesia for Intravitreal Injection: A Systematic Review</p>

Cited by 14 publications

References 25 publications

Cooling Anesthesia for Intravitreal Injection: Results of the Prospective Open-Label, Dose-Ranging COOL-1 Trial

Cooling Anesthesia for Intravitreal Injection: Results of the Prospective Open-Label, Dose-Ranging COOL-1 Trial

Preventive factors, diagnosis, and management of injection-related endophthalmitis: a literature review

Effect of Topical Versus Sub-conjunctival Anaesthesia during Administration of Intravitreal Bevacizumab Injection

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