REDUCTION OF POSTINTRAVITREAL INJECTION PAIN USING ICE: An Open-Label Interventional Randomized Controlled Trial.

Abstract

PURPOSE:

Intravitreal injections of intraocular therapeutic agents are a common and effective treatment for various retinal pathologies. Patient discomfort related to injection is a potential barrier to treatment. Our aim in this study was to evaluate whether cooling the eye using topical ice compresses before intravitreal injection will reduce pain or bleeding.

METHODS:

This randomized controlled open-label study included 42 patients. All patients received a standard topical anesthesia protocol and then were randomly assigned to either receive a placement of ice packs (intervention group) or a room-temperature pack (control group) on the eyelid, 2 minutes before the intravitreal injection. Patients' discomfort, itching, burning and pain (using visual analog scale), and bleeding size (using photographs) were measured 1 and 10 minutes after the injection. Tolerability was calculated by averaging patients' discomfort, itching, burning, and pain scores.

RESULTS:

At 1 minute, pain (1.95 vs. 4.27, P = 0.01) and overall tolerability (1.66 vs. 2.98, P = 0.03) were significantly lower in patients receiving ice packs. At 10 minutes, pain (1.6 vs. 3.73, P = 0.02), burning (0.9 vs. 3.09, P = 0.007), discomfort (2.1 vs. 4.27, P = 0.008), and overall tolerability (1.23 vs. 2.87, P = 0.004) were all significantly lower in the ice group compared with the controls. Bleeding size (area or circumference) was not statistical different between groups.

CONCLUSION:

Topical ice patch administered before intravitreal injection significantly decreased pain and overall tolerability. This simple and inexpensive method may be used to ameliorated pain and improve tolerability.

• Authors: Tal Yahalomi, Idan Hecht, Oded Lagstein, Achia Nemet, Liron Pe'er, Fady Hadad, Ari Keren-Yaar, Rabea Kassem, Zvia Burgansky-Eliash, Asaf Bar, Asaf Achiron
• Journal: Retina (Philadelphia, Pa.) (Retina) Vol. 40 Issue 7 Pg. 1434-1438 (Jul 2020) ISSN: 1539-2864 [Electronic] United States
• PMID: 31305506 (Publication Type: Journal Article, Randomized Controlled Trial)

Chemical References

• Ice

Topics

• Aged
• Eye Pain (diagnosis, etiology, therapy)
• Female
• Humans
• Hypothermia, Induced (methods)
• Ice
• Intravitreal Injections (adverse effects)
• Male
• Pain Measurement (methods)
• Retinal Diseases (drug therapy)
• Treatment Outcome