Study Evaluating the Efficacy and Safety of Chloroprocaine HCl Ophthalmic Gel 3% vs Proparacaine Ophthalmic Solution 0.5% Plus Subconjunctival Lidocaine in Patients Undergoing Intravitreal Injections

This is a prospective, multicenter, randomized, double-masked, controlled Phase 4 clinical trial evaluating the non-inferiority of chloroprocaine hydrochloride ophthalmic gel 3% (IHEEZO) compared with routine anesthesia (topical proparacaine 0.5% plus subconjunctival lidocaine 2%) for ocular surface anesthesia during intravitreal injection (IVT).

Adults scheduled to undergo unilateral intravitreal injection of an FDA-approved anti-vascular endothelial growth factor (anti-VEGF) agent for neovascular age-related macular degeneration, diabetic macular edema, retinal vein occlusion, or diabetic retinopathy will be randomized 1:1 to receive either IHEEZO with a sham subconjunctival procedure or routine anesthesia. Randomization will be stratified by clinical site and baseline ocular dryness severity (Standard Patient Evaluation of Eye Dryness [SPEED] score).

Participants in the experimental arm will receive three topical drops of chloroprocaine ophthalmic gel 3% followed by a sham subconjunctival procedure. Participants in the comparator arm will receive three topical drops of proparacaine 0.5% followed by subconjunctival lidocaine 2%. Standard antiseptic preparation with 5% povidone-iodine will be performed prior to IVT in both arms.

The primary endpoint is the proportion of participants achieving successful ocular surface anesthesia, defined as a pain score of 0 or 1 on a 0-5 ordinal pain scale both immediately before and immediately after IVT. Participants requiring rescue anesthesia prior to or during IVT will be considered treatment failures.

Secondary endpoints include individual and cumulative pain scores, change from baseline in SPEED questionnaire score, and ocular safety assessments including best-corrected visual acuity, intraocular pressure, corneal fluorescein staining (Oxford scale), and treatment-emergent adverse events through Day 7 (±2 days). Participants will be followed for approximately 7 days after injection.

Inclusion criteria

• Able to understand and voluntarily provide written informed consent prior to initiation of any study-specific procedures
• Male or female, age ≥ 18 years
• Scheduled to undergo unilateral, uncomplicated intravitreal injection of an FDA-approved, non-biosimilar anti-VEGF agent in the study eye
• Diagnosis requiring anti-vascular endothelial growth factor (anti-VEGF) treatment, including macular edema (cystoid or diabetic), retinal vein occlusion, diabetic retinopathy, or neovascular age-related macular degeneration
• At least three prior intravitreal anti-VEGF injections in the study eye
• Fewer than 13 intravitreal anti-VEGF injections in the study eye within the last 365 days
• Willing and able to comply with study procedures and follow-up assessments

Exclusion criteria

• Scheduled to undergo simultaneous bilateral intravitreal injection
• Pre-existing eye pain in the study eye
• Fewer than three prior intravitreal anti-VEGF injections in the study eye within 365 days prior to enrollment
• Mental disability or cognitive impairment that prevents reliable pain assessment
• Prisoner
• Pregnant or breastfeeding
• Woman of childbearing potential not using an acceptable method of contraception
• Inability to comply with study procedures or follow-up assessments
• Known sensitivity or allergy to any study medications or related drug classes
• History of resistance to local anesthetics
• History of Ehlers-Danlos syndrome
• Participation in another investigational drug or device study within 30 days prior to screening (unless previously randomized to a control group receiving Eylea, Eylea HD, Lucentis, or Vabysmo)
• Use of pain medication, opioids, analgesics, or NSAIDs (any route) within 24 hours prior to Visit 1
• Clinically significant systemic disease or condition that, in the Investigator's judgment, may compromise safety or study integrity
• Cataract extraction, intraocular surgery, or extraocular surgery within 60 days prior to enrollment that may affect ocular pain
• History of autoimmune disease, graft-versus-host disease, fibromyalgia, uveitis, neurotrophic corneal disease, keratitis or corneal ulceration, uncontrolled glaucoma, or herpetic ocular disease
• History of endophthalmitis or ocular trauma within 3 months prior to enrollment
• Pre-existing subconjunctival hemorrhage or bulbar conjunctival hyperemia
• Chronic ocular pain rated moderate to severe within 1 week prior to Visit 1
• Active bacterial or viral infection in either eye