Evaluating the effectiveness of different topical anesthetic methods in reducing pain during intravitreal injections: a systematic review and meta-analysis

International Journal of Retina and Vitreous

卷:12

Review

Renad Alhomidi Almotiri¹  Zahraa Hussain Alsaggaf²  Yara Hamed Abosabaah³  Sadeem Saad Abdulaziz Alkaluf⁴  Rana Ali A. Algahamdi⁵  Ali Mousa Ahmed Alkhalaf⁴  Ayah Mazen Kurdi⁶  Ishraq Tail Alkhudaidi⁷  Sarah Husam AlJefri⁸ 

[1] College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia

[2] Department of Ophthalmology, College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia

[3] Department of Ophthalmology, Jeddah Eye Hospital, Jeddah, Saudi Arabia

[4] College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia

[5] College of Medicine, King Saud bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia

[6] College of Medicine, Al-Baha University, Al- Baha, Saudi Arabia

[7] College of Medicine, King Faisal University, Al- Ahsa, Saudi Arabia

[8] Makkah Health Cluster, Makkah, Saudi Arabia

关键词: Local anesthesia;    Topical anesthesia;    Pain control;    Pain management;    Intravitreal injections;    Anti-vascular endothelial growth factor;   

DOI  :  10.1186/s40942-026-00892-5

 received in 2026-01-11, accepted in 2026-06-20,  发布年份 2026

来源: Springer

【 摘 要 】

BackgroundThe rapid rise in intravitreal injections (IVIs) for vitreoretinal disorders underscores the need to optimize the procedure and support long-term patient compliance. Patient-reported pain and discomfort remain significant barriers to adherence. This systematic review evaluates the efficacy and safety of various local anesthetic methods for mitigating pain during IVIs.MethodsConducted in accordance with PRISMA guidelines, a comprehensive search of PubMed and Google Scholar was performed to identify English-language randomized controlled trials (RCTs). Eligible studies included patients aged 18 years and older receiving local anesthesia for IVIs, where pain was quantified using standard visual or oral analog scales (0–10 or 0–100).ResultsOur systematic review and meta-analysis included 14 RCTs comprising 1,300 patients. Analysis of topical lidocaine, tetracaine, and proparacaine formulations showed comparable analgesic efficacy, with all agents consistently achieving mild mean Visual Analog Scale (VAS) pain scores. No clinically meaningful superiority was identified among these primary agents (p = 0.62). Adjunctive therapies, particularly physical cooling (e.g., ice patches), demonstrated significant pain-reducing potential. While oxybuprocaine alone was less effective, its combination with physical cooling achieved the lowest mean pain scores. Meanwhile, topical NSAIDs showed limited additional benefit. Regarding safety, subconjunctival anesthetic injections were associated with a significantly higher incidence of subconjunctival hemorrhage and chemosis compared to topical applications, suggesting that topical strategies provide a favorable safety and efficacy profile for routine intravitreal injections.ConclusionIn conclusion, this systematic review and meta-analysis confirms that no single topical anesthetic is superior for intravitreal injections; all primary agents provide comparable, effective pain control. Topical application is safer than subconjunctival injection, which is associated with higher rates of hemorrhage and chemosis. Consequently, clinical protocols should standardize low-risk topical methods and incorporate simple non-pharmacological adjuncts, such as physical cooling, to optimize patient comfort.

【 授权许可】

CC BY   
© The Author(s) 2026

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