April 2011
Volume 52, Issue 14
Free
ARVO Annual Meeting Abstract  |   April 2011
Clinical Comparison of Two Anesthetic Preparations for Intravitreal Injection
Author Affiliations & Notes
  • Ninel Z. Gregori
    Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida
    Ophthalmology, Miami Veterans Affairs Medical Center, Miami, Florida
  • Matthew J. Weiss
    Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida
  • Joyce C. Schiffman
    Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida
  • Edgardo Vega
    Ophthalmology, Miami Veterans Affairs Medical Center, Miami, Florida
  • Linda Kelley
    Ophthalmology, Miami Veterans Affairs Medical Center, Miami, Florida
  • William J. Feuer
    Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida
  • Wei Shi
    Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida
  • Cherrie-Ann Mattis
    Ophthalmology, Miami Veterans Affairs Medical Center, Miami, Florida
  • Footnotes
    Commercial Relationships  Ninel Z. Gregori, None; Matthew J. Weiss, None; Joyce C. Schiffman, None; Edgardo Vega, None; Linda Kelley, None; William J. Feuer, None; Wei Shi, None; Cherrie-Ann Mattis, None
  • Footnotes
    Support  P30EY014801 RPB unrestricted award
Investigative Ophthalmology & Visual Science April 2011, Vol.52, 1697. doi:
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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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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose: : 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.

Methods: : 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.

Results: : 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).

Conclusions: : The data suggest patients prefer the gel preparation, however, the Q-tips may produce a lower IOP spike.

Clinical Trial: : http://www.clinicaltrials.gov NCT01087489

Keywords: injection • age-related macular degeneration • intraocular pressure 
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