Combined Effect of Topical Nepafenac and Topical Anesthesia On Patients' Pain Perception During Intravitreal Anti-Vascular Endothelial Growth Factor Injection

Doi: 10.36351/pjo.v42i3.2369

Abstract

Purpose:  To evaluate the effectiveness of topical Nepafenac (0.1%) eye drops as an adjunct to topical proparacaine for pain relief during intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections, and to compare its effect with topical proparacaine alone.

Study Design:  Quasi-experimental study.

Place and Duration of Study:  Al-Shifa Trust Eye Hospital, Rawalpindifrom July 2025 to October 2025.

Methods:  The study included 150 patients, 30-70 years of age, who underwent intravitreal anti-VEGF injections. Group A (n=75) was given only topical proparacaine, and Group B (n=75) was given combined topical proparacaine and topical Nepafenac (0.1%).Numeric Pain Rating Scale (NPRS) was used for pain.

Results:  The mean age was 60±11years. There were 88 males (58.7%)and right eye was more commonly involved (n = 83, 55.3%). Diabetic patients (n=87, 58%), with proliferative diabetic retinopathy (n=42, 28%) being the most frequent indication for anti-VEGF. No statistically significant difference was observed (Chi-square test,
p = 0.07) regarding pain scores between the two groups. Pearson's correlation analysis revealed a very weak and non-significant association of  Nepafenac (0.1%)use and pain scores (Pearson correlation coefficient = 0.182,
p = 0.26).Pain scores showed no significant association with age (p=0.53), gender (p=0.06), previous injections (p=0.10), or underlying diagnoses (p=0.20). However, a statistically significant difference in pain perception was observed between diabetic and non-diabetic patients (p = 0.015).

Conclusion:  Topical Nepafenac (0.1%)does not alterthe pain perceptionduring intravitreal anti-VEGF injections.