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Anesthesia for Intravitreal Injection: A Systematic Review

Authors Han J, Rinella NT, Chao DL

Received 17 July 2019

Accepted for publication 19 December 2019

Published 26 February 2020 Volume 2020:14 Pages 543—550


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

Jonathan Han, Nicholas T Rinella, Daniel L Chao

Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, CA, USA

Correspondence: Daniel L Chao
Shiley Eye Institute, 9415 Campus Point Drive, La Jolla, CA 92093, USA
Tel +1 858 534-6290
Fax +1 858 534-7985

Background: The intravitreal injection has become one of the most commonly performed procedures in ophthalmology; however, there is no standardized approach to anesthesia during the procedure. The goal of this systematic review is to review approaches to anesthesia for intravitreal injection and look at comparative efficacy between these different anesthetics.
Methods: A systematic review of literature was performed in the MEDLINE, PubMed, Cochrane Library, and databases using the key words “anesthesia”, “pain management”, and “intravitreal injection”. Of the initial 239 search matches, 30 articles were found to be relevant to the topic. 18 studies were excluded as they did not include primary data or did not include the visual analog scale as a primary outcome. The remaining 12 articles were assessed to look at the comparative efficacy of anesthesia and adverse events.
Results: The anesthesia techniques reported include topical methods such as anesthetic eyedrops, anesthetic gels, and anesthetic-soaked pledgets as well as subconjunctival injection of anesthetic. Ultimately, no single anesthetic or delivery mechanism was shown to be superior to the others in a statistically significant way and adverse events were largely insignificant. Limitations of these studies include relatively small sizes of the studies, as well as the lack of masking which may introduce bias.
Conclusion: In the current literature, no type of anesthetic method was found to be superior to another for intravitreal injection. Future studies in this area may lead to new insights into the efficacy of different forms of intravitreal anesthesia.

Keywords: intravitreal injection, anesthesia, pain, management, review

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