Abstract PR511

Abstract

Background & Objectives: The use of intravitreal injection (IVI) has increased dramatically with the therapy for macular degeneration(1). Patients may experience pain during injection leading to sudden movements of the eye, wich can cause intraocular complications(2). The objective of this systematic review was to compare different local anesthetic techniques for IVI to determine the effectiveness of these methods to relieve pain of the patient undergoing intraocular injection. Materials & Methods: For this systematic review, we compared different techniques of local anesthesia with no sedation for intravitreal injection of antiangiogenic agents and steroids. Anesthetic and/or analgesic effect was evaluated by pain scale. Studies to be considered for inclusion were identified by searching the following electronic bibliographic databases: Cochrane, LILACS, PubMed, Scopus, and Web of Science. The methodology of the selected studies was evaluated using the Cochrane risk of bias tool. Results: After searching and comprehensive evaluation 13 randomized clinical trials were retained for the final selection. According to the Cochrane risk of bias tool (figure 1) only three studies presented a low risk of bias for random sequence generation. The reported anesthetic techniques included topical tetracaine, topical proparacaine, tetracaine gel, instilation of 5% lidocaine, 4% lidocaine pledget, 4% topical cocaine, peribulbar injection of lidocaine 2%, subconjunctival injection of lidocaine 2%, lidocaine gel in different concentrations 2,3.5,5,8 and 12%, topical levobupivacaine 0,75%. All techniques presented a low pain score reported by the patients during IVI. Rifkin showed that topical tetracaine has a better anesthetic effect than proparacaine or tetracaine gel(3). When considering subconjunctival injection (SCI) of lidocaine 2%, the interval between the placement of anestesia and IVI is importante. When waiting 5 minutes SCI of lidocaine 2% provides a better anesthetic effect when compared to other techniques(2).Conclusion: All techniques included in this review provides a good analgesia for IVI. The results should be evaluated carefully due to the risk of bias of the studies, specially regarding the random sequence generation.