Patients heading in for an intravitreal injection may cope with the post-procedure pain better after administration of a pre-emptive topical non-steroidal anti-inflammatory agent (NSAID), a new study suggests. Researchers found that administering NSAIDs pre-procedure—specifically, topical nepafenac—was associated with the greatest improvement in pain.

The study evaluated 598 eyes from nine randomized controlled trials that treated patients with a topical NSAID and analyzed post-procedure pain. The team assessed pain on the zero- to 10-point Visual Analog Scale and categorized the data into post-procedure time points of less than one hour, six hours and more than 24 hours.

The investigators observed a low-to-medium risk of bias across the included trials. They noted that the mean pain score was significantly lower following topical NSAID administration relative to controls at every time point, adding that administering NSAIDs before versus after intravitreal injection, as well as topical nepafenac relative to ketorolac or diclofenac, had a greater effect.

“Given the lack of diversity of studies and associated sample size, our findings should be regarded as hypothesis-generating,” the study authors concluded.

Popovic MM, Muni RH, Nichani P, et al. Topical non-steroidal anti-inflammatory drugs for pain from intravitreal injections: a meta-analysis. Ophthalmology. February 13, 2020. [Epub ahead of print].