Survey: technique of performing intravitreal injection among members of the Brazilian Retina and Vitreous Society (SBRV)

Shiroma, Hélio Francisco; Farah, Michel Eid; Takahashi, Walter Yukihiko; Gomes, André Luís; Goldbaum, Mauro; Rodrigues, Eduardo Büchele

doi:10.5935/0004-2749.20150009

Cited by 14 publications

(17 citation statements)

References 17 publications

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“…Surveys of retina specialists in different countries demonstrated a predominance of topical anesthetic eye drops for IVI [5, 23]. Indeed, in all studies included in this systematic review, proparacaine or tetracaine drops were used; eye drops were either combined with other types of anesthetics to relieve the discomfort caused by dilating drops or povidone iodine drops, or as a single anesthetic choice.…”

Section: Discussionmentioning

confidence: 99%

Patient pain during intravitreal injections under topical anesthesia: a systematic review

et al. 2017

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BackgroundIntravitreal injection (IVI) is a very common vitreoretinal procedure, and multiple injections are often required per patient. This systematic review was conducted to evaluate the effectiveness of various local anesthetic techniques in reducing pain during injection.MethodsA systematic review was conducted based on searches of Cochrane, LILACS, PubMed, Scopus, Web of Science, and the gray literature (Google Scholar). The end search date was February 19, 2016, across all databases. We classified pain by converting visual analog scale (VAS) scores (0–100 mm) into Jensen’s classification levels: 0–4, no pain; 5–44, mild pain; 45–74, moderate pain; and 75–100, severe pain. An intervention was considered clinically significant when pain score change was >12 mm on a 100-mm scale.ResultsEight studies out of 23 met the eligibility criteria. The total number of patients was 847. Most studies (5/8 [62.5%]) were at unclear risk of bias because of unclear randomization, thus providing only moderate evidence to this review. The anesthetic techniques included eye drops with proparacaine, tetracaine or cocaine, a lidocaine pledget or gel, and subconjunctival injection of 2% lidocaine or 0.75% levobupivacaine. No study comprised all of the techniques. Pain was mild (VAS scores, 5–44 mm) regardless of anesthetic technique. A clinically significant intervention (pain score change >12 mm) was found for only one study comparing proparacaine drops, lidocaine gel, and subconjunctival lidocaine; in that study, a subconjunctival injection of 2% lidocaine provided the greatest pain reduction. A meta-analysis was not possible due to study heterogeneity.ConclusionsPatient pain during IVI under topical anesthesia is mild regardless of anesthetic technique. A subconjunctival injection of 2% lidocaine could be an option for highly sensitive patients. However, with moderate level of evidence, no single anesthetic technique could be defined as the best option for IVI.Electronic supplementary materialThe online version of this article (doi:10.1186/s40942-017-0076-9) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Patient pain during intravitreal injections under topical anesthesia: a systematic review

et al. 2017

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“…This might become the most common intraocular procedure worldwide [7]. There are many techniques for intravitreal injection, and various practices in terms of aseptic technique, anesthetic use, prophylactic antibiotics, post-injection monitoring, and treatment protocols [8][9][10][11]. However, there is little agreement among clinicians regarding acceptable injection techniques [12,13].…”

Section: Introductionmentioning

confidence: 99%

Which quadrant is less painful for intravitreal injection? A prospective study

Karimi

Mosavi

Jadidi

et al. 2018

Eye

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“…Studies have shown that in most patients IOP returns to safe levels within 30 min after IVI [19-27]. It has been reported, that 89% of patients receiving intravitreal ranibizumab experienced an IOP rise of more than 30 mm Hg at 5 s after injection [23], approximately one third after the first 5 min [16].…”

Section: Considerations Before Injectionmentioning

confidence: 99%

2018 Update on Intravitreal Injections: Euretina Expert Consensus Recommendations

et al. 2018

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Intravitreal injections (IVI) have become the most common intraocular procedure worldwide with increasing numbers every year. The article presents the most up-to-date review on IVI epidemiology and techniques. Unfortunately, important issues related to pre-, peri- and postinjection management lack randomized clinical trials for a final conclusion. Also, a great diversity of approaches exists worldwide. Therefore, expert consensus recommendations on IVI techniques are provided.

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Survey: technique of performing intravitreal injection among members of the Brazilian Retina and Vitreous Society (SBRV)

Cited by 14 publications

References 17 publications

Patient pain during intravitreal injections under topical anesthesia: a systematic review

Patient pain during intravitreal injections under topical anesthesia: a systematic review

Which quadrant is less painful for intravitreal injection? A prospective study

2018 Update on Intravitreal Injections: Euretina Expert Consensus Recommendations

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