# Comparison of different topical anesthetic methods for intravitreal injections: a randomized crossover study

## TL;DR

This study compares different methods of numbing the eye before injections and finds that adding a pledget may help some patients feel less pain.

## Contribution

The study introduces a crossover design to assess the effectiveness of pledget anesthetic in addition to standard drops for intravitreal injections.

## Key findings

- Pain levels were not significantly different between the placebo and pledget groups overall.
- Treatment naïve patients reported lower pain with the addition of a pledget soaked in anesthetic.
- The study found no significant enhancement in anesthesia from using a pledget soaked with proparacaine.

## Abstract

To evaluate the potential adjunctive effect of pledget anesthetic to topical proparacaine applied in a droplet form in patients undergoing intravitreal injections (IVI).

This is a single-centre, prospective, randomized, double-blinded crossover study. 60 patients were included. Patients receiving IVI were given topical 0.5% proparacaine drops then randomized in a 1:1 ratio to receive 0.5% proparacaine soaked pledget or normal saline soaked pledget as placebo. The patients would later be crossed over to receive the alternative intervention. Pain was assessed with a visual analog scale (VAS) and questionnaire immediately afterwards, 10-minutes and 20-minutes after injection.

Pain intensity as assessed on the visual analogue scale was lower for the placebo group compared to the pledget group immediately (2.51 cm vs. 2.8 cm), 10-minutes (1.81 cm vs. 2.13 cm) and 20-minutes (1.23 cm vs. 1.65 cm) after injection, however this was not statistically significant (p = 0.48, p = 0.43, p = 0.24 respectively). However, in a subgroup of treatment naïve patients, the addition of pledget anesthesia may lower pain and make IVI more tolerable.

Additional pledget soaked with proparacaine does not enhance anesthesia compared to solely using topical proparacaine for IVI, except in a subset of treatment naïve patients.

The online version contains supplementary material available at 10.1186/s40942-025-00649-6.