Original StudyREPLACEMENT OF LIDOCAINE GEL WITH TOPICAL PROPARACAINE ANESTHESIA FOR ROUTINE INTRAVITREAL INJECTIONS A Comparative StudyAlex, Varsha MD; Singh, Sumit R. MD; Motevasseli, Tahmineh MD; Cavicchini, Melina MD; Jhingan, Mahima MD; Bartsch, Dirk-Uwe PhD; Cheng, Lingyun MD; Freeman, William R. MDAuthor Information Department of Ophthalmology, Jacobs Retina Center, Shiley Eye Institute, University of California, California, San Diego. Reprint requests: William R. Freeman, MD, Department of Ophthalmology, Jacobs Retina Center, Shiley Eye Institute, UCSD, 9415 Campus Point Drive, La Jolla, CA 92093; e-mail; [email protected] Supported in part by UCSD Vision Research Center Core Grant from the National Eye Institute P30EY022589, NIH grant R01EY016323 (D. U. Bartsch), an unrestricted grant from the Research to Prevent Blindness, NY (W. R. Freeman), and unrestricted funds from the UCSD Jacobs Retina Center. None of the authors has any conflicting interests to disclose. Retina: June 2021 - Volume 41 - Issue 6 - p 1309-1313 doi: 10.1097/IAE.0000000000003013 Buy Metrics AbstractIn Brief Purpose: Lidocaine gel was suggested to be highly effective in providing anesthesia for intravitreal injections but adverse effects include a possibility of making sterilization of the conjunctiva difficult. Hence, we wished to determine the effect of using 0.5% proparacaine drops alone over the use of 3.5% lidocaine hydrochloride gel anesthesia during office-based intravitreal injections. Methodology: This was a case–control study in patients who came routinely to the clinic for antivascular endothelial growth factor injections. Eyes were treated with one of two anesthesia modalities. A total of 216 injections in 120 patients were reviewed. One group (N = 107) underwent anesthesia with 0.5% proparacaine drops, and the control group (N = 109) received 3.5% lidocaine gel. The pain perceived after injection was graded using the numerical rating scale, and score was immediately recorded by the “masked” injecting physician. Results: The mean pain score (±SD) for the proparacaine-only group versus gel group was 1.97 (±1.17) versus 1.76 (±0.92), P value = 0.3174. There was no statistical difference between the 2 groups. Conclusion: 3.5% lidocaine gel is not superior to 0.5% proparacaine drops as patients attained good pain control and excellent rates of overall satisfaction with proparacaine drops alone. Topical 0.5% proparacaine drops is a highly effective form of ocular anesthesia for intravitreal injections. The advantage of drops includes simplicity, lower expense, and easier disinfection with povidone iodine. Proparacaine drops alone can thus be preferred over 3.5% lidocaine hydrochloride ophthalmic gel for anesthesia during office-based intravitreal injections.