Reduction of Postintravitreal Injection Pain Using Ice

Yahalomi, Tal; Hecht, Idan; Lagstein, Oded; Nemet, Achia; Pe’er, Liron; Hadad, Fady; Keren-Yaar, Ari; Kassem, Rabea; Burgansky-Eliash, Zvia; Bar, Asaf; Achiron, Asaf

doi:10.1097/iae.0000000000002608

Cited by 3 publications

(2 citation statements)

References 22 publications

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“…In another study, it was observed that placing an ice pack on the eyelid before IVI reduced postprocedural pain. However, this method was time‐consuming and unwieldy (Yahalomi et al., 2020). The purpose of this study was to evaluate whether cooled anaesthetic eyedrops and antiseptics, used as part of a standard IVI protocol, could be a more straightforward and effective way to alleviate pain and minimise SCH following IVI.…”

Section: Introductionmentioning

confidence: 99%

“…Whilst not detrimental in the short term, the pain and SCH associated with IVI still carry meaningful consequences. Some patients may refrain from enduring the painful monthly visits, while others may abstain from social activities until the SCH subsides (Yahalomi et al., 2020). Poor patient experience may impair the compliance necessary for effectively managing the disease.…”

Section: Introductionmentioning

confidence: 99%

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Pain control and subconjunctival haemorrhage after intravitreal injection using cooled anaesthetic eyedrops and antiseptics: A prospective, double‐blind, randomized controlled trial

Moshkovsky,

Golan,

Aviel Gadot

et al. 2023

Acta Ophthalmologica

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PurposeTo evaluate whether cooled anaesthetic eyedrops and antiseptics alleviate pain and minimise subconjunctival haemorrhage following intravitreal injection.MethodsA prospective, double‐masked, randomised controlled trial of 100 participants receiving either cooled (n = 50) or room temperature (n = 50) topical anaesthetic eyedrops and antiseptics before receiving an injection of bevacizumab. Baseline tolerability was estimated using a self‐reported pain sensitivity questionnaire.ResultsOverall tolerability was comparable between the study group and the control group (0.75 ± 0.13 vs. 0.74 ± 0.14, respectively, p = 0.99). Subconjunctival haemorrhage incidence was similar in both groups (80% vs. 86%, respectively, p = 0.113), as was subconjunctival haemorrhage size (2.75 ± 5.51 mm2 vs. 5.53 ± 10.72 mm2, respectively, p = 0.11). Sub‐group analysis demonstrated that the participants taking daily ocular eyedrops who received cooled anaesthetic eyedrops and antiseptics reported less pain at 10 min and less burning sensation at 24 h compared with matched controls (0.67 ± 1.50 vs. 2.50 ± 3.03, respectively, p = 0.040 and 0.00 ± 0.00 vs. 1.44 ± 2.96, respectively, p = 0.045). Participants who received cooled eyedrops and did not use antithrombotic therapy had smaller‐sized subconjunctival haemorrhages compared with matched controls (1.55 ± 1.87 mm2 vs. 8.29 ± 14.61 mm2, respectively, p = 0.038). Participants with hypertension who received cooled eyedrops had smaller‐sized subconjunctival haemorrhage compared with matched controls (2.33 ± 4.99 mm2 vs. 6.89 ± 12.41 mm2, respectively, p = 0.045).ConclusionThe benefit of using cooled anaesthetic eyedrops and antiseptics to alleviate pain and minimise subconjunctival haemorrhage following intravitreal injection was not proven in the general population. It may be beneficial in part for some patients, such as those who regularly use eyedrops, patients with hypertension or those not on antithrombotic therapy.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pain control and subconjunctival haemorrhage after intravitreal injection using cooled anaesthetic eyedrops and antiseptics: A prospective, double‐blind, randomized controlled trial

Moshkovsky,

Golan,

Aviel Gadot

et al. 2023

Acta Ophthalmologica

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Post-Intravitreal injection pain reduction using topical NSAIDS: A comparative study

Shtayer,

Lily Okrent Smolar,

Elmalak

et al. 2023

European Journal of Ophthalmology

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Purpose To compare the efficacy of two different topical non-steroidal anti-inflammatory drugs (NSAIDs) drops with versus without conservatives after intravitreal injections (IVIs). Design Prospective, randomized, placebo-controlled, single-blinded comparative study. Participants and method A total of 308 eyes of 252 patients receiving an IVI of anti-vascular endothelial growth factor (anti-VEGF) were randomly assigned to receive either a single drop of nepafenac 0.1%, preservative-free diclofenac 0.1%, or artificial tears (control group) immediately after IVI. Primary outcome measure was pain scores immediately, six hours and twenty-four hours post- injection. Results 166 patients received one topical drop of NSAIDS, of which 90 in the diclofenac group and 76 in the nepafenac group. Additional 86 patients were included in the control group. Mean reported pain score was significantly lower at six hours after IVI in the preservative-free diclofenac group (17.1 ± 23.0) than in the nepafenac group (26.2 ± 31.9) and the control group (27.5 ± 29.2) (p = 0.03). At twenty-four hours post-injection there was no statistically significant difference between the groups. Patients reported less pain compared to previous IVIs and none referred to urgent health care, but these findings were not statistically significant. Conclusions The use of topical preservative-free NSAIDs may be superior to preservative- containing NSAIDs in pain relief after IVIs and may be considered as part of the treatment protocol of this population.

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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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Reduction of Postintravitreal Injection Pain Using Ice

Cited by 3 publications

References 22 publications

Pain control and subconjunctival haemorrhage after intravitreal injection using cooled anaesthetic eyedrops and antiseptics: A prospective, double‐blind, randomized controlled trial

Pain control and subconjunctival haemorrhage after intravitreal injection using cooled anaesthetic eyedrops and antiseptics: A prospective, double‐blind, randomized controlled trial

Post-Intravitreal injection pain reduction using topical NSAIDS: A comparative study

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

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