Evaluation of Pain in Intravitreal Bevacizumab Injections

Purpose: To evaluate the correlation between pain associated with intravitreal bevacizumab injection and the location of the injection. Methods: The study included 218 eyes of 218 patients, who received an intravitreal bevacizumab injection at our institution. Pain was measured by the Visual Analog Scale (VAS). Additional parameters recorded included age, sex, indication for the injection, injection site by quadrant, number injections in the study eye, presence of diabetes mellitus, and lens status. Results: Indications for injection included age-related macular degeneration (69.7%), diabetic macular edema (13.3%), neovascularization due to proliferative diabetic retinopathy (6.9%), and cystoid macular edema secondary to retinal vascular occlusions (10.1%). Pain scores on the VAS ranged from 0 to 84, with a mean of 17.4 +/- 17.1. Pain did not correlate significantly with any of the recorded parameters, but a trend was found toward less pain associated with injection in the lower-left quadrant (p = 0.067). Conclusions: This is the largest series studying the pain associated with intravitreal injections and provides a thorough description of the pain associated with this procedure. Since there is no anatomical difference between quadrants, we assume the demonstrated trend indicates that less pain is associated with the location in which it is most convenient for the ophthalmologist to perform the injection.