Materials and Methods: Thirty eyes of 30 patients with macular edema due to central retinal vein and retinal vein branch occlusion were included in this study. Twelve patients received topical (0.5% propacaine), 10 patients received subconjunctival (lidocaine 20 mg/ml, epinephrine 0.0125 mg/ml) and 8 patients received subtenon (lidocaine 20 mg/ml, epinephrine 0.0125 mg/ml+bupivacaine) anesthesia during the application of intravitreal dexamethasone implant. Patients? pain during implant injection was evaluated with visual analog scale.

Results: Fourteeen patients were female and 16 patients were male. There was no significant difference between groups in terms of the patients? age (p=0.304, p>0.05). Intravitreal injection of implant was successfully performed in all cases. The mean pain score after intravitreal injection in topical group was found to be 5±1.67, while the score was 3.0±0.78 in subconjuntival and 0±0.35 in subtenon anesthesia group. Statistically significant difference at an advanced level (p<0.01) was detected in pain scores between the three groups. There were no complications in the topical group while subconjunctival hemorrhage occured in 3 eyes of subconjunctival group and 4 eyes in subtenon group (p=0.029, p<0.05).

Conclusion: Subtenon and subconjunctival anesthesia which provide deeper anesthesia can be considered as an alternative to topical anesthesia to improve patient compliance and prevent rejection of subsequent injections in intravitreal dexamethasone implant injections by 22-gauge needle. Keywords : Intravitreal dexamethasone implant injection, visual analog scale, topical anesthesia, subconjunctival anesthesia, subtenon anesthesia