• Retina/Vitreous

    Review of: Replacement of lidocaine gel with topical proparacaine anesthesia for routine intravitreal injections

    Alex V, Singh S, Motevasseli T, et al. Retina, in press

    This study assessed the use of proparacaine drops alone as an ocular anesthetic during office-based intravitreal injections.

    Study design

    Researchers enrolled patients who routinely came to the clinic for anti-VEGF injections, including 107 patients who underwent anesthesia with 0.5% proparacaine drops and 109 in the control group who received 3.5% lidocaine gel. The masked physician administering the injection immediately graded and recorded the pain perceived after injection using the numerical rating scale.

    Outcomes

    There was no statistical difference in the level of pain or discomfort between the 2 groups.

    Limitations

    The study had few patients, and there was no mention or record of pain or discomfort after the patients left the clinic. It would have been helpful if the researchers had called the patients later that day to assess their comfort level.

    Clinical significance

    Using a gel can be a potential source of post-injection endophthalmitis as the gel might inhibit the betadine from working, especially if the gel is applied first. In addition, gel is usually more expensive than drops, and patients sometimes complain that the gel causes their eyelids to stick, resulting in transient visual blurring. In practice, using only drops is simpler for the doctor or technicians preparing the patient prior to injection. This study should encourage physicians to try using only drops instead of the gel as an anesthetic for intravitreal injections.