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Ninel Z. Gregori, Matthew J. Weiss, Joyce C. Schiffman, Edgardo Vega, Linda Kelley, William J. Feuer, Wei Shi, Cherrie-Ann Mattis; Clinical Comparison of Two Anesthetic Preparations for Intravitreal Injection. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1697.
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To determine which of two topical anesthetic preparations patients prefer for intravitreal injections of ranibizumab with a 32 gauge needle. One preparation was a topical application utilizing three Q-tips soaked in 4% lidocaine; the other was application of 3.5% lidocaine hydrochloride ophthalmic gel.
Randomized prospective clinical trial. Patients who had at least 3 previous intravitreal ranibizumab injections were divided into two strata and randomized to receive one of the two anesthetic preparations. The bilateral stratum, which is reported here, consisted of patients requiring bilateral ranibizumab injections, who were randomly assigned to a different prep in each eye (n=13). Patients’ discomfort level, overall satisfaction with the preparation and injection, as well intraocular pressure (IOP), corneal staining, and subconjunctival hemorrhage (SCH) were compared. The patients were also asked which preparation method they preferred.
For the bilateral patients the discomfort score (1=none to 5=extremely severe) during the preparation was 2.4 (s.d.=1.2,range=1 to 4) vs 2.0 (s.d.=0.8, range=1 to 3) in the Q-tip vs gel group, respectively (P=0.3, paired t-test). Discomfort score during the injection was 1.8 (s.d.=0.9, range=1 to 4) in the Q-tip group vs 2.3 (s.d.=0.8, range=1 to 3) in the gel group (P=0.028, paired t-test.) Mean overall satisfaction score (1=very unsatisfied to 5=very satisfied) with the anesthetic preparation was 4.2 (s.d.=1.0, range=2 to5) with Q-tip vs 4.3 (s.d.=1.1, range=2 to 5) with gel (P=0.8, paired t-test). Mean IOP immediately after injection was 42 mmHg (s.d.=8, range=24 to 57) vs 48 (s.d.=10, range=35 to 69) in the Q-tip vs gel eyes respectively (P=0.029). There was no difference in the extent of SCH (P=0.3, paired t-test) or corneal staining (P=0.8, paired t-test). When asked the next day which preparation they preferred, 8 patients preferred gel, 1 preferred Q-tip, and 4 said they were equal (P=0.039, McNemar’s test).
The data suggest patients prefer the gel preparation, however, the Q-tips may produce a lower IOP spike.
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