September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
A Comparison of Pain Scores and Severity of Subconjunctival Hemorrhage Following Intravitreal Injection in Patients Receiving Subconjunctival Anesthesia with 2% Lidocaine versus 2% Lidocaine with Epinephrine
Author Affiliations & Notes
  • Javed Sayed
    Department of Ophthalmology and Visual Science, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
  • Matthew Ohr
    Department of Ophthalmology and Visual Science, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
  • Barbara Mihalik
    Department of Ophthalmology and Visual Science, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
  • Footnotes
    Commercial Relationships   Javed Sayed, None; Matthew Ohr, None; Barbara Mihalik, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 2675. doi:
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      Javed Sayed, Matthew Ohr, Barbara Mihalik; A Comparison of Pain Scores and Severity of Subconjunctival Hemorrhage Following Intravitreal Injection in Patients Receiving Subconjunctival Anesthesia with 2% Lidocaine versus 2% Lidocaine with Epinephrine. Invest. Ophthalmol. Vis. Sci. 2016;57(12):2675.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Despite anesthesia, intravitreal injections may result in pain and subconjuctival hemorrhage. Epinephrine, a potent vasoconstrictor, is used in synergy with lidocaine to augment anesthesia and reduce bleeding. This study tested the hypothesis that subconjuctival anesthesia consisting of 2% lidocaine with epinephrine improves immediate post intravitreal injection pain scores and severity of subconjunctival hemorrhage compared to subconjuctival 2% lidocaine alone.

Methods : Patients of a single retinal specialist receiving intravitreal injections of vascular endothelial growth factor inhibitors for clinically significant macular edema or exudative age related macular degeneration were recruited to participate in the study. All subjects in the study received anesthesia consisting of a single drop of topical proparacaine followed by an application of 4% lidocaine soaked pledgets x 3. Subjects were then randomized to receive subconjuctival anesthesia with 2% lidocaine or 2% lidocaine with epinephrine 2 minutes prior to the intravitreal injection. Following the intraocular injection photos of the eye were taken and pain scores were assessed by survey. The severity of subconjuctival hemorrhage was graded at a later date from the photos by a masked third party.

Results : Twelve eyes from 9 subjects received 2% lidocaine with epinephrine while 7 eyes from 6 subjects received 2% lidocaine for subconjunctival anesthesia. Wilcoxon-Mann-Whitney tests showed no difference in pain scores (p = 0.3045) or severity of subconjuctival hemorrhages (p = 0.3065) across groups.

Conclusions : Although the sample size is limited, the results suggest that subconjuctival 2% lidocaine with epinephrine does not improve pain scores or the severity of subconjuctival hemorrhage following intravitreal injection of vascular endothelial growth factor inhibitor.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

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