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Melvin Rabena, Carlos Quezada, Jack Giust, Michelle Villanueva, Layne Bone, Dante Joseph Pieramici; Optimal Incubation Period following Topical Anesthesia prior to Intravitreal Injections. Invest. Ophthalmol. Vis. Sci. 2014;55(13):583.
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To determine optimal waiting time after topical anesthesia prior to intravitreal injection, so as to reduce the pain associated with injection.
Ninety-six patients received a single anti-vegf intravitreal injection. All patients received 2 drops of proparacaine ophthalmic solution and one bolus 0.5ml drop of lidocaine gel. The patients were randomized to incubation times following topical anesthesia of 5, 10 and 15 minutes prior to intravitreal injection. Patients self-reported pain immediately following intravitreal injection according to the Wong-Baker FACES pain rating scale (0=no pain to 5=highest pain). The investigator administering the pain scale was masked to the incubation period.
All patients completed the assessment within 2 minutes following intravitreal injection. All injections were completed without complications. The overall mean pain score was 1.13 (median =1, range = 0 to 5 with 5 being the most severe). Subgroups showed that the lowest mean pain score was obtained in patients who waited 10 minutes (0.86) compared to the other groups (5 minutes = 0.97, p = 0.65; 15 minutes=1.62, p = 0.01).
In this study using only topical anesthesia the optimal waiting period after topical anesthesia using lidocaine gel for intravitreal injection was between 5 and 10 minutes. Longer incubation periods may lead to inactivation of the anesthetic. This information is of particular value in busy retina practices so as to facilitate efficient patient care while maximizing patient comfort.
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