Materials and Methods: In this interventional study, 88 eyes of 88 patients who received IV anti-vascular endothelial growth factor (anti- VEGF) therapy were included. Fourty three patients received IV 2.0 mg/0.05 ml afl ibercept injection with 30-gauge needle and 45 patients received IV 0.05 mg/0.05 ml ranibizumab injection with 30-gauge needle. The diagnoses of the patients were: 40 age related macular degeneration, 39 diabetic macular edema, 4 central and 5 branch retinal vein oclusion. Immediately after the injection, patients were asked to grade their pain using the visual analog scale (VAS) of 0 (no pain) to 10 (unbearable/ worst pain). The main outcome measure was the pain score assessment. Additional parameters recorded included demographics (age, gender, education level) and clinical characteristics (indication for the injection, number of previous IV injections).

Results: The VAS pain scores in the afl ibercept and ranibizumab groups were 1.67± 0.81 (range, 0-7) and 1.24 ± 1.15 (range, 0-6), respectively (p = 0.10). Multivariable regression analysis revealed that pain perception was significantly lower in patients of older age, male patients, with higher number of previous injections and higher educational status.

Conclusions: Pain associated with both afl ibercept and ranibizumab IV injection is generally mild, and may be associated with epidemiologic factors and the number of previous IV injection. Keywords : Aflibercept, Intravitreal injection, Pain, Ranibizumab, Visual analogue scale