Intra-chamber lidocaine in addition to tetracaine eyedrop anesthesia in clear cornea phacoemulsification

Abstract

We have been successfully using topical tetracaine 1% anesthesia in clear corneal phacoemulsification since 1992. Adding intracameral lidocaine to topical anesthesia in cataract surgery has been reported since 1996. We examined the effectiveness of intracameral lidocaine 1%, which we dyed with methylene blue 2% in 600 cases. During surgery we merely inject 0.3 ccl lidocaine 1% twice over the iris under a shield of a viscoelastic substance. After only a few seconds time of action we remove it again from the anterior chamber. With intracameral lidocaine 1% postoperative pain was totally eliminated for one to two hours, and usually no pain was felt thereafter. Non of our cases showed any negative signs of postoperative reaction of the eye. With the use of intracameral lidocaine we were able to omit pre- and postoperative systemic pain medication completely. This has proven to be very advantageous in elderly outpatients. Staining the lidocaine with methylene blue 2% helps prevent mixups and emphasizes its significance. Yet, an intracameral blue flow was not visible enough to determine the spread of lidocaine. Intracameral lidocaine represents an ideal addition to topical tetracaine anesthesia in clear corneal phacoemulsification.