To evaluate the relationship between the site of injection and the severity of pain in patients receiving intravitreal bevacizumab (IVB).

Patients who were candidates to received IVB were randomized into 4 groups: superotemporal (ST), superonasal (SN), inferotemporal (IT), and inferonasal (IN) site for injection. Visual Analog Scale (VAS) was used to indicate the severity of pain. The relationship between severity of pain and injection site, number of previous injections, age, sex, indication for injection, best corrected visual acuity (BCVA) as well as central macular thickness (CMT) was evaluated.

The average pain score for the whole study groups was 2.86 ± 2.2. Indications for injection were diabetic macular edema (84 %), neovascular age-related macular degeneration (7.6%), and macular edema secondary to retinal vein occlusion (8.4%). The VAS pain scores in superonasal, inferonasal, superotemporal, and inferotemporal groups were 1.51 ± 1.73, 3.02 ± 2.25, 3.96 ± 1.97 and 2.97 ± 2.11 respectively. Severity of pain was correlated significantly with the site of injection and sex. There was a negative correlation between pain scores and number of previous injections. Changes of BCVA and CMT were comparable between study groups. Severity of pain was not associated with age and indication of injection. Female gender was associated with higher pain score. No significant complication was observed.

Superotemporal quadrant was the most painful and superonasal quadrant was the least painful site for intravitreal injection of bevacizumab. The pain severity score was associated significantly with the injection site, number of injections and female gender