Lidocaine gel anesthesia for intravitreal drug administration

Purpose: To describe the use of topical gel anesthesia for intravitreal injection drug delivery. Methods: The first group (n = 12) of patients is a crossover group of patients who on separate occasions received intravitreal injections after both 2% lidocaine subconjunctival injection (SC) and 2% lidocaine topical gel anesthesia using 30-gauge needle. The second group (n = 16) is a consecutive group of patients who received either SC (n = 8) or gel (n = 8) anesthesia before intravitreal injection of triamcinolone using 27.5-gauge needle. Descriptive and numerical pain analog scale was used to assess pain sensation. Results: There was no difference in pain score between gel and SC within the first group (P = 0.67, paired, nonparametric test) and no difference in pain score comparing patients who had either SC or gel anesthesia before 27.5-gauge intravitreal injections (P = 0.82, unpaired t-test) in the second group. However, there were significant differences in incidence of chemosis (P < 0.001) and subconjunctival hemorrhage (P < 0.001) after injection versus gel anesthesia in both groups. Conclusion: Anesthesia with lidocaine 2% gel provides satisfactory patient comfort for administration of intravitreal injection and causes less chemosis and hemorrhage than SC anesthesia.