Which quadrant is less painful for intravitreal injection? A randomized clinical trial

Session Details

Session Title: Free Paper Session 8: Vitreoretinal Surgery III

Session Date/Time: Friday 08/09/2017 | 08:00-09:30

Paper Time: 08:18

Venue: Room 111

First Author: : S.Moradian IRAN

Co Author(s): :    H. Nikkhah   S. Mosavi                          

Abstract Details


To evaluate the relationship between the site of injection and the severity of pain in patients receiving intravitreal bevacizumab (IVB).


Ophthalmic Research centre, Shahid Beheshti University of Medical Sciences


In this interventional prospective clinical trial 1004 eyes of 1004 patients who were candidates to received IVB were randomized into 4 groups: superotemporal, superonasal, inferotemporal, and inferonasal site for injection. Visual Analog Scale (VAS) was used to indicate the severity of pain. The relationship between severity of pain and injection site, number of previous injections, age, sex, indication for injection, best corrected visual acuity (BCVA) as well as central macular thickness (CMT) was evaluated.


Indications for injection were diabetic macular edema (84 %), neovascular age-related macular degeneration (7.6%), and macular edema secondary to retinal vein occlusion (8.4%). The average pain score for the whole study groups was 2.86 ± 2.2. It was noted that the VAS pain scores in superanasal, inferanasal, superatemporal, and inferatemporal groups were 1.51 ± 1.73, 3.02 ± 2.25, 3.96 ± 1.97 and 2.97 ± 2.11 respectively. Severity of pain was correlated significantly with the site of injection, number of injections and sex. Changes of BCVA and CMT were comparable between study groups. Severety of pain was not associated with age and indication of injection.


Supratemporal quadrant was the most painful and supranasal quaderant was the least painful site for intravitreal injection of bevacizumab. Female gender was associated with higher pain score. The pain severity score was significantly associated with the injection site, number of injections and female gender.

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