title: TOPICAL APRACLONIDINE REDUCES PAIN AFTER INTRAVITREAL INJECTIONS: A Double-Blind Randomized Controlled Trial.
abstract: OBJECTIVE
  To evaluate the efficacy of topical apraclonidine in reducing pain and subconjunctival hemorrhage (SCH) after intravitreal injections (IViT).
  
  
  METHODS
  A prospective, randomized, double-blinded study. Thirty-nine patients were examined twice, at each monthly IViT of 1.25 mg/0.05 mL bevacizumab. Patients were randomly assigned to receive either topical apraclonidine 0.5% or placebo to the treated eye, 30 minutes before the first IViT. At their second IViT, the intervention was switched. Thirty minutes after the injection, SCH size was measured by a slit lamp, and pain was assessed by the numerical rating scale (NRS-11).
  
  
  RESULTS
  Mean pain score was 1.69 (SD ±1.44) in the apraclonidine group and 3.28 (SD ±2.27) in the control group (P < 0.001). Phakic patients had a greater pain reduction after topical apraclonidine (P < 0.001). Subconjunctival hemorrhage incidence was 41% in the apraclonidine group and 51.3% in the control group (P = 0.503). Mean SCH size was 1.71 mm (SD ±5.83) in the apraclonidine group and 3.25 mm (SD ±6.41) in the control group (P = 0.253). After topical apraclonidine, there was a smaller reduction in SCH size in patients with choroidal neovascularization or hypertension (P = 0.003 and 0.044, respectively), and a greater reduction in phakic patients (P = 0.048).
  
  
  CONCLUSIONS
  Topical apraclonidine 0.5%, administered 30 minutes before IViT, significantly decreased pain by a factor of 1.94. It did not decrease the incidence or size of SCH in the entire cohort, but only in several subpopulations.
authors.affiliation: *Department of Ophthalmology, The Edith Wolfson Medical Center, Holon, Israel; †The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; and ‡The Hebrew University Hadassah Medical School, Jerusalem, Israel.
authors.forename: Oded
authors.initials: O
authors.lastname: Lagstein
authors.forename: Noa
authors.initials: N
authors.lastname: Ben-Artzi
authors.forename: Asaf
authors.initials: A
authors.lastname: Achiron
authors.forename: Achia
authors.initials: A
authors.lastname: Nemet
authors.forename: Maroun
authors.initials: M
authors.lastname: Khreish
authors.forename: Elisha
authors.initials: E
authors.lastname: Bartov
authors.forename: Zvia
authors.initials: Z
authors.lastname: Burgansky-Eliash
mesh_terms: D000287:Administration, Topical; D058647:Adrenergic alpha-2 Receptor Agonists / Q000008:administration & dosage; D000368:Aged; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage; D000068258:Bevacizumab / Q000008:administration & dosage*; D003000:Clonidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D004311:Double-Blind Method; D058447:Eye Pain / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D058449:Intravitreal Injections / Q000009:adverse effects; D008297:Male; D009883:Ophthalmic Solutions / Q000008:administration & dosage; D010147:Pain Measurement; D011446:Prospective Studies; D012164:Retinal Diseases / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D058647:Adrenergic alpha-2 Receptor Agonists; D020533:Angiogenesis Inhibitors; D009883:Ophthalmic Solutions; D000068258:Bevacizumab; C016986:apraclonidine; D003000:Clonidine