Nepafenac 0.3% Drop Effectively Relieves Pain Post-Intravitreal Injection

Richard Kaplan, MD

Although topical non-steroidal anti-inflammatory drugs (NSAIDs) and pressure patching have been the traditional pain reduction routes for patients following an intravitreal injection, a single eye drop may be more successful.

The use of nepafenac 0.3% suspension drops has proven to be a significantly effective pain reducer post-intravitreal injection at both the 6-hour and 24-hour points compared to placebo, according to new data presented at the American Society of Retina Specialists (ASRS) 36th Annual Meeting in Vancouver, British Columbia.

Led by Richard Kaplan, MD, from the New York Eye and Ear Infirmary of Mount Sinai in New York, New York, a group of researchers prospectively assessed the pain levels of 56 eyes from 56 patients set to receive injections of either bevacizumab (Avastin, Genentech), aflibercept (Eyelea, Regeneron), or ranibizumab (Lucentis, Genentech), as measured by Numeric Pain Rating Scale (NSPS) scores (range, 1 to 10) at 6 and 24 hours after the injection. Kaplan and colleagues noted that “since pain scores were significantly non-normal, data were analyzed using a non-parametric randomization-based analysis of covariance.”

Patients were randomized to receive either a single drop of nepafenac 0.3% (n = 19), a pressure patch for 2 hours after injection (n = 18), or a single drop of preservative-free tears as the control group (n = 19). In total, 11 patients had age-related macular degeneration, 34 had a diagnosis of diabetic macular edema, and 9 had retinal vein occlusion.

Those receiving the nepafenac drop reported raw NSPS pain scores of 0.8 ±0.3 at the 6-hour mark, lower than both the 1.3 ±0.4 and 2.5 ±06 recorded with placebo and the pressure patch, respectively (P = .0753). At the 24-hour mark, the nepafenac group’s score dropped to 0.1 ±0.1, in comparison with 0.4 ±0.2 and 0.9 ±0.4 for the control and pressure patch groups, respectively (P = .0477). When utilizing Dwass-Steel-Critchlow-Fligner (DSCF) multiple pairwise comparison testing, the raw NSPS scores were significantly different (P = .0385) between nepafenac compared with placebo.

“After controlling for age, gender, number of prior injections, and physician administering the injection, patients in the nepafenac group had significantly lower pain scores than those in the control group at 6 hours (-1.3 ±0.6; P = .047) and 24 hours (-0.7 ±0.3; P = .047),” Kaplan and colleagues wrote. Additionally, in comparison to the patch group, the nepafenac group reported lower adjusted NSPS scores at 6 hours (-1.27 ±0.64 compared to -0.78 ±0.67; P <.05) and 24 hours post-injection (-0.66 ±0.33 compared to -0.37 ±0.35; P <.05).

Although the group administered pressure patching had lower pain scores than the control cohort, it was not statistically significant at 6 hours (P = 0.24) or 24 hours (P = 0.29). When comparing pain scores for those given nepafenac and the patch, no significant difference was observed at either time point (6 hours, P = .16; 24 hours, P = .08). It was also noted that women reported higher pain scores (P = .016).

Kaplan and colleagues noted that “pain negatively impacts the patient’s experience,” and with treatment burden already dominating concerns in the retinal community, the pain reduction is welcome—as long as the therapies remain unaffected. They concluded that “more studies are needed to determine the most effective method to maximize the patient’s experience without sacrificing outcome.”

The study, “Pain Control Following Intravitreal Injection Using Topical Nepafenac 0.3% or Pressure Patching: A Prospective, Randomized, Placebo-Controlled Trial,” was presented at ASRS.

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