EFFECT OF TOPICAL NSAIDS (DICLOFENAC 0.1%, NEPAFENAC 0.1%, NEPAFENAC 0.3%) ON PAIN MANAGEMENT DURING INTRAVITREAL INJECTIONS

Abstract

Purpose: To evaluate the analgesic efficacy of various topical nonsteroidal anti-inflammatory drugs (NSAIDs) as adjuncts to standard topical anesthesia during Intravitreal injection (IVI) administration.
Methods: Prospective, consecutive-allocation study enrolled 406 patients undergoing IVIs at a tertiary care center. Participants were placed into four groups receiving a topical NSAID 20–30 minutes pre-procedure: control (no NSAID), diclofenac 0.1%, nepafenac 0.1%, or nepafenac 0.3%. The primary outcome was patient-reported pain measured immediately following IVI on the Visual Analog Scale (VAS). Statistical analyses included one-way ANOVA, Kruskal-Wallis testing, and multivariable linear regression. (Trial registration: ChiCTR2500110461)
Results: Baseline demographics, including age (P = .919), gender (P = .783), and history of previous IVI (P = .919), were balanced across all four groups. A highly significant difference in mean VAS scores was observed among the study groups (F [3,402] = 9.99, P < .001; χ2[3] = 25.40, P < .001). The Control group reported the highest pain intensity (3.60 ± 1.90). All NSAID groups demonstrated significantly lower pain levels: diclofenac 0.1% (2.71 ± 1.48), nepafenac 0.1% (2.59 ± 1.53), and nepafenac 0.3% (2.50 ± 1.52). Multivariable regression confirmed a significant treatment effect (P < .001) with medium effect size (Partial η2 = .069). Additionally, prior IVIs (P = .212) and age (P = .09) did not influence VAS.

Conclusions: Pre-treatment with topical NSAIDs significantly reduces pain during IVI compared with standard anesthesia alone. For vitreoretinal practices, administering topical NSAID drops 20-30 minutes before IVI is a safe, low-resource strategy that optimizes patient comfort and may boost long-term treatment adherence.