ArticleInternational journal of retina and vitreous2017
Patient pain during intravitreal injections under topical anesthesia: a systematic review.
Article in International journal of retina and vitreous, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03871062 (A Prospective, Randomised, Single-masked Comparison of Topical Anesthesia and Topical Combined Subconjunctival), which is not on this map. Cited by 16 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
A Prospective, Randomised, Single-masked Comparison of Topical Anesthesia and Topical Combined Subconjunctival (Two-step) Anesthesia in Intravitreal Injection
Who cites it
16 citing papers in PubMed, 26 citations in OpenAlex.
- Long term evaluation of the safety and efficacy of local cooling anesthesia during intravitreal injections: The COOL-2 Trial.PloS one · 2026Trial
- Randomized Safety and Feasibility Trial of Ultra-Rapid Cooling Anesthesia for Intravitreal Injections.Ophthalmology. Retina · 2020Trial
- Eyelid retraction discomfort with cotton-tipped applicator, unimanual and speculum intravitreal injection techniques: Eyelid retraction technique randomized comparison trial (Eyelid RETRACT).Indian journal of ophthalmology · 2020Trial
- Anticipated and Actual Pain Intensity in Patients Receiving Intravitreal Injections: A Cross Sectional Study.Nursing open · 2026Article
- The safety and effectiveness of anesthetic drops for intravitreal drug administration: a meta-analysis.Frontiers in medicine · 2026Review
- Pain perception during intravitreal injections is related to the timing of instilling anesthetic eyedrops.International ophthalmology · 2024Observational
- Potential Risk Factors for Ocular Pain in Patients Undergoing Multiple Intravitreal Injections of Anti-Vascular Endothelial Growth Factor.Clinical ophthalmology (Auckland, N.Z.) · 2024Article
- Preventive factors, diagnosis, and management of injection-related endophthalmitis: a literature review.Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie · 2022Review
- Novel Combined Lidocaine/Povidone Iodine Delivery System for Preintravitreal Injection.Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics · 2022Article
- Treatment-Emergent Adverse Events in Gene Therapy Trials for Inherited Retinal Diseases: A Narrative Review.Ophthalmology and therapy · 2020Review
- Functional, structural, and molecular identification of lymphatic outflow from subconjunctival blebs.Experimental eye research · 2020Article
- Intravitreal Injections with Vascular Endothelial Growth Factor Inhibitors: A Practical Approach.Ophthalmology and therapy · 2020Article
- Anesthesia for Intravitreal Injection: A Systematic Review.Clinical ophthalmology (Auckland, N.Z.) · 2020Review
- Current Evidence for the Prevention of Endophthalmitis in Anti-VEGF Intravitreal Injections.Journal of ophthalmology · 2018Review
- 880 kHz ultrasound treatment for drug delivery to the vitreous humor.American journal of translational research · 2018Article
- Assessment of Patient Pain Experience During Intravitreal Ranibizumab and Aflibercept Injection.Middle East African journal of ophthalmologyArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIntravitreal injection (IVI) is a very common vitreoretinal procedure, and multiple injections are often required per patient. This systematic review was conducted to evaluate the effectiveness of various local anesthetic techniques in reducing pain during injection.
methodsA systematic review was conducted based on searches of Cochrane, LILACS, PubMed, Scopus, Web of Science, and the gray literature (Google Scholar). The end search date was February 19, 2016, across all databases. We classified pain by converting visual analog scale (VAS) scores (0-100 mm) into Jensen's classification levels: 0-4, no pain; 5-44, mild pain; 45-74, moderate pain; and 75-100, severe pain. An intervention was considered clinically significant when pain score change was >12 mm on a 100-mm scale.
resultsEight studies out of 23 met the eligibility criteria. The total number of patients was 847. Most studies (5/8 [62.5%]) were at unclear risk of bias because of unclear randomization, thus providing only moderate evidence to this review. The anesthetic techniques included eye drops with proparacaine, tetracaine or cocaine, a lidocaine pledget or gel, and subconjunctival injection of 2% lidocaine or 0.75% levobupivacaine. No study comprised all of the techniques. Pain was mild (VAS scores, 5-44 mm) regardless of anesthetic technique. A clinically significant intervention (pain score change >12 mm) was found for only one study comparing proparacaine drops, lidocaine gel, and subconjunctival lidocaine; in that study, a subconjunctival injection of 2% lidocaine provided the greatest pain reduction. A meta-analysis was not possible due to study heterogeneity.
conclusionsPatient pain during IVI under topical anesthesia is mild regardless of anesthetic technique. A subconjunctival injection of 2% lidocaine could be an option for highly sensitive patients. However, with moderate level of evidence, no single anesthetic technique could be defined as the best option for IVI.
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.