Study about Topical Anesthesia with Ropivacaine and Proparacaine for Intravitreal Injection Procedures

Purpose: we designed a study to evaluate the effectiveness of ropivacaine in combination with proparacaine as topical anesthesia for intravitreal injections and to compare it with proparacaine alone.

Methods: Prospective study. We compared two different Anesthetic Methods (AM); proparacaine 0.5%+ropivacaine 0.2% (AM 1) and proparacaine 0.5% alone (AM 2). One hundred and fifty five sequential patients undergoing intravitreal injections were randomized into 1 of 3 groups: Group 1 was a crossover group in which patients undertook bilateral same-day intravitreal therapy with different anesthetic method for each eye and compared pain sensation between the two eyes. Group 2 & 3 undertook unilateral therapy, received topical anesthesia with anesthetic method 1 & 2, respectively, and were asked to grade pain sensation. A 0 to 10 pain scale representing no pain (0) to severe pain (10) was used.

Results: In the first group the 38 patients (76 eyes) were given different anesthesia for each eye before same-day bilateral intravitreal injection with 30-gauge needle. The average pain score was 2.61±2.021 for AM 1 and 3.26±2.522 for AM 2. The difference in pain score between the two anesthetic methods was statistically significant (P=0.039). For group 2 the average pain score was 2.38±1.795 while for group 3 it was 2.66±2.014 (P=0.426).

Conclusion: We conclude that combining proparacaine 0.5 percent, a short-acting anaesthetic, with ropivacaine 0.2 percent, a long-acting anaesthetic, appears to be an effective anaesthetic option that provides patients with high rates of pain control and overall satisfaction during the office-based intravitreal injection procedure, and may be superior to proparacaine 0.5 percent alone. A future manufacturing of ropivacaine's ophthalmic solution would be extremely beneficial and could give another effective method of topical anaesthetic for a variety of eye procedures.