Topical Apraclonidine Lessens Pain After Intravitreal Therapy

Jennifer Garcia

November 22, 2016

Topical apraclonidine administered 30 minutes before intravitreal injection (IViT) significantly reduces pain and, in some groups, subconjunctival hemorrhage (SCH). The results of this study were published online November 10 in Retina.

Given the common use of intravitreal injections for many ophthalmologic diseases, "[t]his may significantly improve patients' comfort and may promote patients' compliance with treatment," write Oded Lagstein, MD, from the Edith Wolfson Medical Center, Holon, Israel, and colleagues.

As part of a prospective, randomized, double-blind single-center study, the researchers enrolled 39 patients (>18 years of age) receiving IViT with bevacizumab. They recruited patients between August 2014 and February 2015 and randomly assigned them to the treatment group (one drop of 0.5% topical apraclonidine) or the control group (one drop topical normal saline). The eyedrops were applied to the treated eye 30 minutes before IViT injection. The researchers used slit-lamp examination to evaluate for presence and size of SCH and assessed pain using a numerical rating scale 30 minutes after the procedure.

Patients underwent the procedure again 1 to 2 months later in a crossover fashion.

Among patients receiving apraclonidine, the mean pain score was reduced by almost half compared with patients in the control group (1.69 ± 1.44 vs 3.28 ± 2.27, respectively).

There was no overall difference between the groups in the incidence of SCH (41% in the apraclonidine group vs 51.3% in the placebo group; P = .503), but apraclonidine was associated with a reduction in the mean size of SCH compared with the control group (1.71 mm2 vs 3.25 mm2).

At the time of IViT, all patients received routine anesthesia, which included oxybuprocaine HCl 0.4% drops and lidocaine HCl 2% gel before bevacizumab injection. There were no adverse effects reported with apraclonidine use.

The mean age of enrolled patients was 77.9 years, 56% were women, 62% were phakic, 38% were pseudophakic, and 77% had a history of hypertension.

The study excluded patients using antiplatelet agents or anticoagulants or those with a history of bleeding diathesis, except for patients using acetylsalicylic acid (≤100 mg/day).

The authors acknowledge study limitations such as the introduction of bias by having patients sign an informed consent release (Hawthorne effect). In addition, the researchers did not measure intraocular pressure (a cause of post-IViT pain) because the need for topical anesthetic would have hindered pain evaluation.

Funding source was not disclosed. The authors have disclosed no relevant financial relationships.

Retina. Published ahead of print November 10, 2016. Abstract

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