Effect of Topical Bromfenac 0.09% on Pain Following Intravitreal Antivascular Endothelial Growth Factor Injections

Purpose: To evaluate the effect of topical bromfenac 0.09% on pain following intravitreal (IVT) injection of antivascular endothelial growth factor (anti-VEGF) medications in patients diagnosed as having choroidal neovascularization secondary to age-related macular degeneration or other etiologies, diabetic macular edema, diabetic retinopathy, or macular edema associated with retinal vein occlusion. Methods: A total of 78 adult patients scheduled to receive bilateral anti-VEGF IVT injections were randomized to receive topical bromfenac 0.09% in 1 eye and artificial tears in the fellow eye (control) immediately before the anti-VEGF treatment at 2 academic institutions from March 2021 to June 2022. Pain was evaluated using the Wong-Baker FACES Pain Rating Scale (score range, 0–10) and the Short-Form McGill Pain Questionnaire (score range, 0–5) at baseline (preinjection) and 5 minutes, 6 hours, and 24 hours following injection. Wilcoxon signed-rank sum test was used for statistical comparisons. Results: In total, 156 eyes were analyzed. Mean baseline pain scores were similar between the bromfenac 0.09% and control groups. Five minutes after injection, eyes randomized to receive bromfenac 0.09% had significantly less pain compared with control eyes receiving artificial tears, on both the Wong-Baker FACES scale (mean raw score, 2.29 vs 2.79; P = .0275) and the McGill Pain Questionnaire (mean raw score, 1.13 vs 2.36; P = .0135). No significant difference in pain scores was noted at 6 hours or 24 hours post–IVT injection. Conclusions: Bromfenac 0.09% solution administered to the study eye before IVT anti-VEGF injection reduced pain 5 minutes after injection in comparison with artificial tears. There was no difference in pain between the 2 groups at 6 hours or 24 hours post–IVT injection.