1
|
Kulikov AN, Vasiliev AS, Kalinicheva YA, Maltsev DS. Topical bromfenac in VEGF-driven maculopathies: topical review and meta-analysis. BMC Ophthalmol 2024; 24:369. [PMID: 39180057 PMCID: PMC11344392 DOI: 10.1186/s12886-024-03650-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 08/19/2024] [Indexed: 08/26/2024] Open
Abstract
BACKGROUND Topical non-steroidal anti-inflammatory drugs have the potential to reduce treatment burden and improve outcomes of anti-VEGF therapy for a number of retinal disorders, including neovascular age-related macular degeneration, diabetic macular edema, and retinal vein occlusions. In this review, we focused on the advantages of topical bromfenac as an adjunct to intravitreal anti-VEGF therapy in VEGF-driven maculopathies. METHODS Cochrane Library, PubMed, and EMBASE were systematically reviewed to identify the relevant studies of neovascular age-related macular degeneration, diabetic macular edema, macular edema associated with retinal vein occlusion, myopic choroidal neovascularization, and radiation maculopathy which reported changes in central retinal thickness, visual acuity, and the number of anti-VEGF injections needed when anti-VEGF therapy was combined with topical bromfenac. RESULTS In total, ten studies evaluating bromfenac as an adjunct to anti-VEGF therapy were identified. Five studies were included in meta-analysis of the number of injections and five studies were included in the analysis of changes in central retinal thickness. A statistically significantly lower number of intravitreal injections (p = 0.005) was required when bromfenac was used as an adjunct to anti-VEGF therapy compared to anti-VEGF monotherapy with pro re nata regimen. At the same time, eyes receiving bromfenac as an adjunct to anti-VEGF therapy demonstrated non-inferior outcomes in central retinal thickness (p = 0.07). Except for one study which reported better visual outcomes with combined treatment, no difference in visual acuity or clinically significant adverse effects were reported. CONCLUSIONS This literature review and meta-analysis showed that topical bromfenac can be considered as a safe adjunct to anti-VEGF therapy with a potential to reduce the treatment burden with anti-VEGF drugs requiring frequent injections without compromising improvement of central retinal thickness or visual acuity.
Collapse
Affiliation(s)
- Alexei N Kulikov
- Department of Ophthalmology, Military Medical Academy, 21, Botkinskaya str., St. Petersburg, 194044, Russia
| | - Alexander S Vasiliev
- Department of Ophthalmology, Military Medical Academy, 21, Botkinskaya str., St. Petersburg, 194044, Russia
| | - Yana A Kalinicheva
- Department of Ophthalmology, Military Medical Academy, 21, Botkinskaya str., St. Petersburg, 194044, Russia
| | - Dmitrii S Maltsev
- Department of Ophthalmology, Military Medical Academy, 21, Botkinskaya str., St. Petersburg, 194044, Russia.
| |
Collapse
|
2
|
SakallioĞlu AK, Kaya S, Garİp R, Güçlü H. COMPARISON OF THE EFFECTS OF EIGHT DIFFERENT TOPICAL NONSTEROIDAL ANTI-INFLAMMATORY DRUGS ON REDUCING INTRAVITREAL INJECTION-INDUCED PAIN. Retina 2024; 44:1196-1202. [PMID: 38437826 DOI: 10.1097/iae.0000000000004085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
PURPOSE To compare topical nonsteroidal anti-inflammatory drug (NSAID) efficacy on intravitreal injection-induced pain reduction and determine the most efficient topical NSAID. METHODS This randomized-controlled study included 662 eyes of 662 patients. Based on the types of NSAID administered before intravitreal injection, eight subgroups were formed. In the control group, a sterile saline solution was applied instead of NSAIDs. The visual analog scale was used to assess pain scores after intravitreal injection. The visual analog scale scores were noted immediately and 6 hours following injection (sixth hour). RESULTS Nepafenac 0.3%, nepafenac 0.1%, and bromfenac 0.09% had the lowest scores, immediately after and after 6 hours, with no significant differences. Diclofenac and ketorolac had higher visual analog scale scores than the first trio but lower scores than the control group. Flurbiprofen, pranoprofen, and indomethacin did not significantly affect immediate pain; however, at the sixth hour, the visual analog scale scores were significantly reduced. CONCLUSION Nepafenac 0.3%, nepafenac 0.1%, and bromfenac 0.09% were the most effective NSAIDs for pain reduction. Although some NSAIDs did not have a significant effect on immediate pain, they all provided significant benefits at the sixth hour.
Collapse
Affiliation(s)
| | | | - Rüveyde Garİp
- Trakya University School of Medicine, Department of Ophthalmology, Edirne, Turkey; and
| | - Hande Güçlü
- Trakya University School of Medicine, Department of Ophthalmology, Edirne, Turkey; and
| |
Collapse
|
3
|
Lee DH, Kim M, Choi EY, Chin HS, Kim M. Efficacy of Pretreatment with Preservative-Free Topical Bromfenac in Improving Post-Intravitreal-Injection Pain: A Prospective Pilot Study. J Clin Med 2022; 11:jcm11144172. [PMID: 35887936 PMCID: PMC9319687 DOI: 10.3390/jcm11144172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/06/2022] [Accepted: 07/14/2022] [Indexed: 11/24/2022] Open
Abstract
(1) Background: To determine the analgesic effect of pretreatment topical bromfenac instillation in patients undergoing intravitreal anti-VEGF treatment. (2) Methods: A prospective, non-randomized pilot study was conducted in patients scheduled to receive repeated intravitreal anti-VEGF injections at a single tertiary hospital. Before the planned second injection, the patients received topical bromfenac eye drops twice a day for 3 days. At 1, 6, and 24 h after the first and second injections, the post-injection pain scores were determined using the numerical rating scale (NRS) telephonically. (3) Results: A total of 28 patients were enrolled in this study. After the first intravitreal injection, the NRS pain scores were 4.04 ± 1.90 at 1 h, 1.57 ± 1.75 at 6 h, and 0.93 ± 1.27 at 24 h. The pain scores after the second intravitreal injection significantly decreased at each measurement time point (p = 0.002, 0.055, and 0.004, respectively) compared to the first injection. (4) Conclusions: The use of topical bromfenac eye drops before intravitreal injection can lead to a significant improvement in injection-related pain scores, which is the basis for a future large-scale randomized comparative study.
Collapse
Affiliation(s)
- Dong-Hyun Lee
- Department of Ophthalmology, Inha University School of Medicine, Incheon 22332, Korea; (D.-H.L.); (H.-S.C.)
- Inha Vision Science Laboratory, Inha University School of Medicine, Incheon 22332, Korea
- Department of Ophthalmology, Yonsei University College of Medicine, Seoul 03722, Korea; (M.K.); (E.-Y.C.)
| | - Minha Kim
- Department of Ophthalmology, Yonsei University College of Medicine, Seoul 03722, Korea; (M.K.); (E.-Y.C.)
| | - Eun-Young Choi
- Department of Ophthalmology, Yonsei University College of Medicine, Seoul 03722, Korea; (M.K.); (E.-Y.C.)
| | - Hee-Seung Chin
- Department of Ophthalmology, Inha University School of Medicine, Incheon 22332, Korea; (D.-H.L.); (H.-S.C.)
- Inha Vision Science Laboratory, Inha University School of Medicine, Incheon 22332, Korea
| | - Min Kim
- Department of Ophthalmology, Yonsei University College of Medicine, Seoul 03722, Korea; (M.K.); (E.-Y.C.)
- Correspondence: ; Tel.: +82-2-2019-3440
| |
Collapse
|
4
|
Karakahya RH. Anterior Chamber Paracentesis Offers a Less Painful Experience During Intravitreal Anti-vascular Endothelial Growth Factor Administration: An Intraindividual Study. Cureus 2021; 13:e20051. [PMID: 34987930 PMCID: PMC8718047 DOI: 10.7759/cureus.20051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction: In order to improve comfort and compliance to treatment of the patient during the intravitreal injections (IVIs), relieving pain may help and provide getting better results. The purpose of the study was to evaluate the efficacy of anterior chamber paracentesis on pain perception and the factors related to pain perception during intravitreal injection procedures. Material and methods: This prospective randomized study includes 212 eyes of 106 patients scheduled for bilateral IVI of ranibizumab 0.5 mg/0.05 cc under topical anesthesia. All patients underwent full ophthalmologic examination, including intraocular pressure (IOP), anterior chamber depth (ACD), and axial length (AL) measurements. Group 1 received IVI following anterior chamber paracentesis (ACP) and group 2 received IVI without ACP. Intraocular pressure was measured five minutes and 30 minutes after the procedure. Pain perception was assessed by visual analogue scale (VAS) grading from 0 to 10. Results: Mean VAS score for groups 1 and 2 was recorded as 0.51±1.00 and 1.32±1.50, respectively. Correlation analysis revealed a positive correlation between VAS score and history of previous IVI, preinjection IOP values, and an inverse correlation with the presence of reflux in both groups, in addition to inverse correlation with ACD in group 2. Conclusions: ACP may offer a comfortable, effective, and less painful alternative to prevent the acute rise in IOP after IVI, especially in patients with small anterior chambers, small vitreous volumes, with a history of multiple injections, and in patients with advanced glaucomatous optic neuropathy.
Collapse
|
5
|
Alshahrani ST, Rubin U, Gupta V, Gonder T, Sharma S. Reflux, Intraocular Pressure Variation and Pain Following Intravitreal Ranibizumab Injections Using 30-Gauge or 32-Gauge Needles for Patients With Retinal Pathologies: A Randomized Clinical Trial. Cureus 2021; 13:e14320. [PMID: 33968530 PMCID: PMC8101509 DOI: 10.7759/cureus.14320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
PURPOSE To compare reflux, intraocular pressure (IOP) variation and pain following intravitreal (IV) injections using 30-gauge and 32-gauge needles in patients with retinal pathologies in Saudi Arabia. METHODS A double-blind randomized clinical trial was conducted in 2018. Participants were randomized to receive IV injections of Ranibizumab using 30-gauge (Gr1) or 32-gauge (Gr2) needles. The amount of reflux of injected material, IOP before (IOP1) and five minutes after injection (IOP2) were measured. The patient-perceived pain score was assessed using a visual analogue score (VAS). Outcome variables were compared. RESULTS The study sample was comprised of 86 eyes (86 patients) in each group. Gender (P=0.76), laterality (P=0.55) and age (P=1.0) were not different between groups. The reflux in Gr1 [34.9% (95% confidence interval {CI}, 24.8; 45.0)] was significantly higher compared to Gr2 [22.1% (95% CI, 13.3; 30.9)] (P=0.007). The median pain score was 1 in both Gr1 [interquartile range (IQR) 1.0: 3.0] and Gr2 (IQR 0.0; 2.0) (P=0.04). Among 56 eyes without reflux in Gr1, the IOP1 and IOP2 were 13.6±2.7 mmHg and 16.4±5.0 mmHg, respectively. Among 67 eyes without reflux in Gr2, the IOP1 and IOP2 were 13.6±2.9 mmHg and 17.0±5.2 mmHg, respectively. The change in percentage in IOP in Gr1 and Gr2 was not significantly different (Mann Whiney P=0.3). CONCLUSIONS IV injection given by 30-gauge needle compared to 32-gauge needle resulted in greater patient-perceived pain and more reflux of injected material from the injection site. An increase in IOP was not associated with the gauge of the needle used for IV injection.
Collapse
Affiliation(s)
- Saeed T Alshahrani
- Ophthalmology Department, King Fahad Medical City, Riyadh, SAU.,Ophthalmology, Queens University, Kingston, CAN
| | - Uriel Rubin
- Ophthalmology, Queens University, Kingston, CAN
| | | | - Tom Gonder
- Ophthalmology, Queens University, Kingston, CAN
| | | |
Collapse
|
6
|
Control of Pain in Intravitreal Injections: Evaluation of Combination Topical Anesthetics and Non-steroidal Anti-inflammatory Drops: A Randomized, Placebo-Controlled Clinical Trial. Ophthalmol Retina 2020; 5:308-309. [PMID: 32858247 DOI: 10.1016/j.oret.2020.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 11/21/2022]
|
7
|
Popovic MM, Muni RH, Nichani P, Kertes PJ. Topical Nonsteroidal Anti-inflammatory Drugs for Pain Resulting from Intravitreal Injections: A Meta-Analysis. Ophthalmol Retina 2020; 4:461-470. [PMID: 32199867 DOI: 10.1016/j.oret.2020.01.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 01/27/2020] [Accepted: 01/31/2020] [Indexed: 11/29/2022]
Abstract
TOPIC The role of topical nonsteroidal anti-inflammatory drugs (NSAIDs) for the reduction of ocular pain after intravitreal injections (IVIs) has been explored. To provide clarity on the evidence for these agents, the present meta-analysis of randomized controlled trials (RCTs) was undertaken. CLINICAL RELEVANCE No standard of care regimen exists for the management of pain resulting from IVIs. METHODS A systematic literature search was conducted on Ovid MEDLINE, EMBASE, and Cochrane Central from inception through July 2019. The RCTs that treated patients with a topical NSAID and assessed postprocedural pain were included. Risk of bias was assessed using the Cochrane guidelines. For all analyses, weighted mean differences (WMDs) with 95% confidence intervals (CIs) were reported. Random effects models were used for all analyses. The primary analysis analyzed pain on a 0- to 10-point visual analog scale. Literature estimates were categorized into the following postprocedure time point groups: 1 hour or less, 1 to 24 hours (although data were available only at 6 hours), and 24 hours or more. A subgroup analysis stratified studies based on agent and preprocedure versus postprocedure administration. RESULTS From 241 results, 9 RCTs and 598 eyes were included. A low to medium risk of bias was found across the included studies. The mean pain score on a 0-to-10 visual analog scale was significantly lower after topical NSAID administration relative to control at 1 hour or less after IVI (WMD, -1.01 units; 95% CI, -1.38 to -0.65; P < 0.001), 6 hours after IVI (WMD, -2.17 units; 95% CI, -2.67 to -1.68; P < 0.001; threshold met for clinical significance, defined as WMD >1.2 units), and more than 24 hours after IVI (WMD, -0.75 units; 95% CI, -1.11 to -0.38; P < 0.001). A greater effect size was seen with administration of NSAIDs before versus after IVI, as well as topical nepafenac relative to ketorolac or diclofenac. DISCUSSION At 6 hours after the procedure, NSAIDs provide a clinically meaningful reduction in pain relative to a control group. The administration of NSAIDs before the procedure, specifically topical nepafenac, was associated with the greatest improvement in pain relative to the control group.
Collapse
Affiliation(s)
- Marko M Popovic
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | - Rajeev H Muni
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada; Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Canada
| | - Prem Nichani
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Peter J Kertes
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada; John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, Toronto, Canada.
| |
Collapse
|
8
|
Raevis J, Shrier EM, Hariprasad SM. Intravitreal Injections: Minimizing the Risk and Maximizing Comfort. Ophthalmic Surg Lasers Imaging Retina 2020; 51:5-8. [DOI: 10.3928/23258160-20191211-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
9
|
VITREOUS PROSTAGLANDIN E2 CHANGES AFTER TOPICAL ADMINISTRATION OF DICLOFENAC 0.1%, INDOMETHACIN 0.5%, NEPAFENAC 0.3%, AND BROMFENAC 0.09. Retina 2019; 40:1838-1845. [PMID: 31800462 DOI: 10.1097/iae.0000000000002674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the vitreous concentration of different nonsteroidal anti-inflammatory drugs (NSAIDs) after topical administration and the related prostaglandin E2 (PGE2) levels in patients undergoing pars plana vitrectomy. METHODS A prospective, randomized, investigator-masked study was performed. One hundred four patients scheduled for a pars plana vitrectomy for an epiretinal membrane or a macular hole were randomized to receive topical diclofenac 0.1%, indomethacin 0.5%, nepafenac 0.3%, bromfenac 0.09%, or placebo 3 days before surgery. At the beginning of surgery, a sample of undiluted vitreous was collected in each patient to assess NSAIDs concentration and PGE2 levels. RESULTS The median vitreous concentrations were 203.35 (interquartile range 146.54-264.18) pg/mL for diclofenac, 243.45 (interquartile range 156.96-365.37) pg/mL for nepafenac, 438.21 pg/mL (interquartile range, 282.52-645.87) for its active metabolite amfenac, 350.14 (interquartile range, 290.88-481.95) pg/mL for indomethacin, and 274.59 (245.43-358.25) pg/mL for bromfenac. Vitreous PGE2 levels were significantly lower for all the NSAIDs groups compared with the control group (P < 0.001). A statistically significant higher vitreous PGE2 level was found in the diclofenac group compared with the other NSAIDs groups (P < 0.05). CONCLUSION Topical NSAIDs achieve sufficient vitreous concentration to decrease vitreous PGE2 levels compared with the control group. The different efficacy in reducing PGE2 concentration may affect the management of posterior segment inflammation.
Collapse
|
10
|
Schechter BA. Use of topical bromfenac for treating ocular pain and inflammation beyond cataract surgery: a review of published studies. Clin Ophthalmol 2019; 13:1439-1460. [PMID: 31534309 PMCID: PMC6682171 DOI: 10.2147/opth.s208700] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 06/27/2019] [Indexed: 01/20/2023] Open
Abstract
Topical ophthalmic nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat postoperative inflammation and pain following cataract surgery and for treatment and prophylaxis of pseudophakic cystoid macular edema (CME). Bromfenac is a brominated NSAID with strong in vitro anti-inflammatory potency. Like other ophthalmic NSAIDs, bromfenac is often used outside of the cataract surgery setting. This paper provides an overview of bromfenac’s preclinical ocular pharmacology and pharmacokinetics, followed by a review of 23 published clinical studies in which various marketed bromfenac formulations were used for conditions other than cataract surgery or pseudophakic CME. These include: post-refractive eye surgery; macular edema associated with diabetes, uveitis, or retinal vein occlusion; inflammation associated with age-related macular degeneration; pain related to intravitreal injections; and other ocular anterior segment and surface disorders with an inflammatory component. The published evidence reviewed supports the safety and effectiveness of bromfenac in these additional ophthalmic indications. Bromfenac was well tolerated when given alone or in combination with intravitreal anti-vascular endothelial growth factor agents, topical corticosteroids, or topical mast-cell stabilizers. The most common adverse event reported was ocular irritation. No serious adverse events (ie, corneal epithelial disorders) were reported, although the majority of studies did not systematically evaluate potential side effects. Corneal complications, such as melts reported with diclofenac and ketorolac, were not observed with bromfenac in the studies. In summary, published study data support the clinical utility of bromfenac in various ocular disorders beyond post-cataract surgery. Additional studies are warranted to further define the potential role of bromfenac ophthalmic solution in clinical practice.
Collapse
Affiliation(s)
- Barry A Schechter
- Cornea and Cataract Service, Florida Eye Microsurgical Institute, Boynton Beach, FL, USA
| |
Collapse
|
11
|
Wentz SM, Price F, Harris A, Siesky B, Ciulla T. Efficacy and safety of bromfenac 0.075% formulated in DuraSite for pain and inflammation in cataract surgery. Expert Opin Pharmacother 2019; 20:1703-1709. [DOI: 10.1080/14656566.2019.1645834] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Scott M Wentz
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Alon Harris
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Brent Siesky
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Thomas Ciulla
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN, USA
- Midwest Eye Institute, Indianapolis, IN, USA
- Clearside Biomedical, Alpharetta, GA, USA
| |
Collapse
|
12
|
Kaplan RI, Drinkwater OJ, Lee RH, Chod RB, Barash A, Giovinazzo JV, Gologorsky D, Jansen ME, Rosen RB, Gentile RC. Pain Control after Intravitreal Injection Using Topical Nepafenac 0.3% or Pressure Patching: A Randomized, Placebo-Controlled Trial. Ophthalmol Retina 2019; 3:860-866. [PMID: 31221565 DOI: 10.1016/j.oret.2019.04.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 04/20/2019] [Accepted: 04/22/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE Pain after an intravitreal injection (IVI) can last up to 7 days and negatively impacts the patient's experience, potentially reducing treatment compliance. We prospectively evaluated topical nepafenac 0.3% suspension and patching for the reduction of pain after IVI. DESIGN Randomized controlled trial. PARTICIPANTS Sixty patients receiving an IVI of bevacizumab, aflibercept, or triamcinolone acetonide in 1 eye. METHODS Participants were randomized equally to receive either a single drop of nepafenac 0.3%, a pressure patch for 2 hours, or a single drop of preservative-free artificial tears (control group). A single-blinded placebo-controlled design was used to mask the topical treatment used. Pain was assessed using the Numeric Pain Rating Scale that ranged from 0 to 10 (horizontal pain scale). Because pain scores were not normally distributed, statistical analysis was performed using a nonparametric randomization-based analysis of covariance. MAIN OUTCOME MEASURE Pain scores. RESULTS Fifty-six and 53 patients of the 60 patients enrolled completed the 6- and 24-hour follow-ups, respectively. Numeric Pain Rating Scale scores at 6 and 24 hours after IVI were lower in the nepafenac group (0.8±0.3 and 0.1±0.1, respectively; n = 18) and the patching group (1.3±0.4 and 0.4±0.2, respectively; n = 19) compared with the control group (2.5±0.6 and 0.9±0.4, respectively; n = 19). After controlling for age, gender, number of prior injections, and physician administering the injection, patients in the nepafenac group reported significantly lower pain scores than those in the control group at 6 hours (1.3±0.6 less; P = 0.047) and 24 hours (0.7±0.3 less; P = 0.047). Although the patching group reported lower pain scores than the control group, this was not statistically significant (6 hours, P = 0.24; 24 hours, P = 0.29). CONCLUSIONS Nepafenac 0.3% was effective as a single drop in reducing pain at 6 and 24 hours after IVI compared with placebo. Limited patching was associated with lower pain scores than placebo, but the difference was not statistically significant. Additional studies are needed to determine the most effective method to maximize the patient's experience after an IVI without sacrificing outcomes.
Collapse
Affiliation(s)
- Richard I Kaplan
- Retina Service, Department of Ophthalmology, New York Eye & Ear Infirmary of Mount Sinai, New York, New York
| | - Owen J Drinkwater
- Retina Service, Department of Ophthalmology, New York Eye & Ear Infirmary of Mount Sinai, New York, New York; Weill-Cornell Medical College, New York, New York
| | - Rachel H Lee
- Retina Service, Department of Ophthalmology, New York Eye & Ear Infirmary of Mount Sinai, New York, New York
| | - Ross B Chod
- Retina Service, Department of Ophthalmology, New York Eye & Ear Infirmary of Mount Sinai, New York, New York
| | - Alexander Barash
- Retina Service, Department of Ophthalmology, New York Eye & Ear Infirmary of Mount Sinai, New York, New York
| | - Jerome V Giovinazzo
- Retina Service, Department of Ophthalmology, New York Eye & Ear Infirmary of Mount Sinai, New York, New York
| | - Daniel Gologorsky
- Retina Service, Department of Ophthalmology, New York Eye & Ear Infirmary of Mount Sinai, New York, New York
| | - Michael E Jansen
- Retina Service, Department of Ophthalmology, New York Eye & Ear Infirmary of Mount Sinai, New York, New York
| | - Richard B Rosen
- Retina Service, Department of Ophthalmology, New York Eye & Ear Infirmary of Mount Sinai, New York, New York
| | - Ronald C Gentile
- Retina Service, Department of Ophthalmology, New York Eye & Ear Infirmary of Mount Sinai, New York, New York; Department of Ophthalmology, NYU Winthrop Hospital, Mineola, New York.
| |
Collapse
|
13
|
Georgakopoulos CD, Plotas P, Kagkelaris K, Tsapardoni F, Makri OE. Analgesic Effect of a Single Drop of Nepafenac 0.3% on Pain Associated with Intravitreal Injections: A Randomized Clinical Trial. J Ocul Pharmacol Ther 2019; 35:168-173. [PMID: 30688558 DOI: 10.1089/jop.2018.0113] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To evaluate the analgesic effect of nepafenac 0.3% in patients undergoing intravitreal injections (IVI) of antivascular endothelial growth factors. METHODS This is a single-center, prospective, randomized, blinded, triple-arm, placebo-controlled interventional study. Patients were randomized into 3 Groups. Group 1 (n = 33) received nepafenac 0.1%, Group 2 (n = 32) received nepafenac 0.3%, and Group 3 (n = 31) received placebo 40 min before IVI. Using the short form of the McGill Pain Questionnaire (SF-MPQ), pain intensity was assessed with the visual analog scale (VAS), the Main Component of the SF-MPQ, and the present pain intensity (PPI) scores immediately and 6 h postinjection. RESULTS Immediately after IVI, the VAS pain score was statistically significantly lower in patients treated with nepafenac 0.1% and 0.3%, compared with placebo (P < 0.001 and P = 0.001, respectively). The PPI scores were statistically significantly lower when nepafenac 0.1% or 0.3% was instilled compared with placebo (P = 0.01 and P < 0.0001, respectively). The Main Component of the SF-MPQ scores were statistically significantly lower after nepafenac 0.1% and 0.3% administration compared with placebo (P = 0.001 and P < 0.001, respectively). Six hours post-IVI the nepafenac 0.3% demonstrated statistically significantly higher analgesic effect compared with nepafenac 0.1% and placebo as this was indicated by the VAS pain score (P = 0.013 and P < 0.00001, respectively) and by the PPI score (P = 0.01 and P < 0.00001, respectively). CONCLUSIONS A single instillation of nepafenac 0.1% or 0.3% before IVI could effectively alleviate the IVI-related pain. The 0.3% formula exerts its analgesic effect more intensively at 6 h after the IVI.
Collapse
Affiliation(s)
| | - Panagiotis Plotas
- Department of Ophthalmology, Medical School, University of Patras, Patras, Greece
| | | | - Foteini Tsapardoni
- Department of Ophthalmology, Medical School, University of Patras, Patras, Greece
| | - Olga E Makri
- Department of Ophthalmology, Medical School, University of Patras, Patras, Greece
| |
Collapse
|
14
|
Makri OE, Tsapardoni FN, Plotas P, Aretha D, Georgakopoulos CD. Analgesic Effect of Topical Nepafenac 0.1% on Pain Related to Intravitreal Injections: A Randomized Crossover Study. Curr Eye Res 2018; 43:1061-1064. [PMID: 29634375 DOI: 10.1080/02713683.2018.1461908] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE To evaluate the analgesic effect of nepafenac 0.1%, a topical non-steroidal anti-inflammatory agent, in patients undergoing treatment with intravitreal injections (IVIs). MATERIAL AND METHODS It is a single center, prospective, randomized, double-blinded, placebo-controlled, crossover interventional study. Fifty-two patients scheduled to undergo IVI of anti-vascular endothelial growth factors were included in the study. Patients were randomized in a 1:1 ratio to receive topical nepafenac 0.1% or placebo 1 h before subsequent IVIs. Using the short form of the McGill Pain Questionnaire (SF-MPQ), pain intensity was assessed with the Visual Analogue Scale (VAS), the Main Component of the SF-MPQ (MC-SF-MPQ), and the Present Pain Intensity (PPI) scores immediately and 6-h post-injection. RESULTS The VAS pain score was statistically significant lower immediately and 6-h post-IVI in patients treated with nepafenac (p = 0.001 and < 0.001, respectively). The MC-SF-MPQ scores were also statistically significant lower after nepafenac administration at both time points (p < 0.001). Finally, the PPI score was statistically significant lower when nepafenac was instilled before IVI (p = 0.015 immediately and p < 0.001 at 6-h post-injection). CONCLUSIONS A single drop of nepafenac 0.1% before IVI could effectively alleviate the IVI-related pain immediately and up to 6 h after the injection.
Collapse
Affiliation(s)
- Olga E Makri
- a Department of Ophthalmology, Medical School , University of Patras , Patras , Greece
| | - Foteini N Tsapardoni
- a Department of Ophthalmology, Medical School , University of Patras , Patras , Greece
| | - Panagiotis Plotas
- a Department of Ophthalmology, Medical School , University of Patras , Patras , Greece
| | - Diamanto Aretha
- b Department of Anesthesiology and Intensive Care Medicine, Medical School , University of Patras , Patras , Greece
| | | |
Collapse
|
15
|
Makri OE, Tsapardoni FN, Pagoulatos DD, Pharmakakis N, Georgakopoulos CD. Diclofenac for pain associated with intravitreal injections: a prospective, randomized, placebo-controlled study. Clin Exp Ophthalmol 2017; 45:867-874. [DOI: 10.1111/ceo.12988] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 05/10/2017] [Accepted: 05/12/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Olga E Makri
- Department of Ophthalmology, Medical School; University of Patras; Patras Greece
| | - Foteini N Tsapardoni
- Department of Ophthalmology, Medical School; University of Patras; Patras Greece
| | | | - Nikolaos Pharmakakis
- Department of Ophthalmology, Medical School; University of Patras; Patras Greece
| | | |
Collapse
|