Abstract
Purpose :
Intravitreal injections (IVI) are a primary method of treatment for a variety of retinal conditions such as age-related macular degeneration (AMD). Patients often report significant post-injection pain and there is no definitive pain management in place. Controlling this is critical for patient comfort and consequently compliance. Loteprednol drops are widely used to treat pain and inflammation, however, it has not been studied as a treatment for pain following IVI. This study aims to explore the role of loteprednol in reducing pain after IVI and hypothesizes that topical administration of loteprednol immediately after IVI will significantly lessen postoperative pain.
Methods :
64 participants receiving routine IVI for AMD were randomized into two groups of a double-blinded placebo-controlled study receiving either 1 drop of loteprednol or artificial tears immediately after the IVI procedure. Pain scores were measured at 2-hours, 1-day, and 1-week post IVI. Pain was assessed using a numeric pain rating scale on a 10-pt range. Patients were given an analgesic pill log and artificial tear log to track any analgesic or artificial tear use during the first week after injection.
Results :
Following IVI the average pain score 2 hours afterward was 3.31 and 2.41, and at 1 day, 0.97 and 0.71, for control and treatment groups respectively. Loteprednol patients had a 27% (p = 0.13) and 26% (p= 0.77) decrease in their pain score compared to the control at 2 hours and 1 day respectively. There was greater variance in the control group compared to the treatment group (2.40 and 2.05 at 2 hours and 1.75 and 1.14 at 1 day for control and treatment respectively). 22% of the treatment arm reported no pain at all compared to 12.5% in the control arm. The treatment arm had 3 times more qualitative improved experience compared to the control arm.
Conclusions :
Our study shows a clinically significant trend towards improved pain control with loteprednol after IVI, although statistical significance was not achieved in this trial. The treatment arm had nearly twice the number of people who experienced no pain at all and 3 times more qualitative improved experience compared to the control. The difference in variance also indicates more consistent pain control using loteprednol. Possible improvements for future studies include increasing the power and refining methods for data collection.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.