Intracameral Lidocaine Injection Research Articles

Corneal endothelial follow‐up after intracameral injection of lidocaine, tropicamide and phenylephrine for mydriasis during cataract surgery

Corneal endothelial follow‐up after intracameral injection of lidocaine, tropicamide and phenylephrine for mydriasis during cataract surgery

Evaluation of deep topical fornix block versus topical anesthesia in patients undergoing implantable collamer lens procedure

Background and aimLocal anesthesia nowadays became more popular in the ophthalmic surgery, especially in implantable collamer lens (ICL) procedure, with fewer complications and more patient satisfaction. Here we design a study to evaluate deep topical fornix nerve block (DTFNBA) versus topical anesthesia.MethodsA double blinded randomized prospective controlled study of 107 eyes that were scheduled for implantable collamer lens procedure was included and divided randomly into two groups, group I topical anesthesia (n = 53), group II DTFNBA (n = 54). The two groups were monitored for pain and patient compliance.ResultsIn group I, receiving topical anesthesia 27 patients (50.09%) reported pain, especially with implantation of the lens, tucking of the lens footplates and peripheral iridectomy that necessitated intracameral lidocaine injection. The others (n = 26) showed different grades of discomfort that was tolerated without the need for intracameral lidocaine. 40 patients (74.07%) in group II (DTFNBA), tolerated the surgery well, and slight discomfort was reported as a sensation of heaviness during the tucking of footplates. None of the patients had pain strong enough to require intracameral injection of lidocaine (p < 0.05).ConclusionsPlacing the anesthetic in the fornix makes the DTFNBA more effective and reliable block.

Phacoemulsification under topical anesthesia alone versus topical anesthesia with intracameral lodocaine injection

Purpose: goal was to study the intra-operative pain experienced by patients when topical alone was used compared with topical anesthesia with intracameral lidocaine injection. To study the patient and surgeon satisfaction when the two different types of anesthesia are used. Setting/Venue: Regional Institute of Medical Sciences, Imphal, India. Methods: 40 patients of cataract divided into two groups, A and B each containing 20 patients were included in the study. phacoemulsification was performed on group A under topical anesthesia with proparacaine hydrochloride 0.5% and on group B under topical anesthesia along with intracameral infiltration of 2% lidocaine. Un co-operative patients, those with previous ocular trauma and corneal opacities were excluded from the study. All patients in both groups were operated by the same surgeon. The surgeon and patient satisfaction score was entered in a standardized proforma. Results: 6 patients in group A felt no pain while 3 patients felt pain upto the extent that 0.5 cc of 2% lidocaine was needed to infiltrate at the phaco port site. Thereafter the procedure was competed comfortably and pain free. Mean phacoemulsification time was 2.5 minutes and mean operation time was 30 minutes. In group B, the patients were operated after infiltration of 0.5 cc 2% lidocaine injection. 16 patients were operated pain free and 4 patients had mild pain. The mean phacoemulsification time was 2.2 minutes and the mean operation time was 30 minutes Conclusions: The intracameral infiltration of 2% lidocaine injection with topical anesthesia is superior to topical anesthesia with proparacaine hydrochloride alone during phacoemulsification ensuring patients and surgeons comfort. None of the patients in any group showed the complication as sometimes seen in periocular and retrobulbar anesthesia

Evaluation of the analgesic effect of intracameral lidocaine hydrochloride injection on intraoperative and postoperative pain in healthy dogs undergoing phacoemulsification

To evaluate the intraoperative and postoperative analgesic effects of intracameral lidocaine hydrochloride injection in dogs undergoing phacoemulsification. 12 healthy Beagles with healthy eyes. Dogs were randomly assigned to receive 1 of 2 intracameral injections: 2% lidocaine hydrochloride solution (0.3 mL) or an equivalent amount of balanced salt solution (BSS). All dogs were treated with acepromazine (0.05 mg/kg, i.v.) and cefazolin (30 mg/kg, i.v.), and tropicamide drops were topically applied to the eyes. Anesthesia was induced with propofol and maintained with isoflurane. The initial end-tidal isoflurane concentration was maintained at 1.2%. Heart rate, respiratory rate, arterial blood pressure, esophageal temperature, inspired and end-tidal isoflurane concentrations, and oxygen saturation were recorded every 5 minutes. The allocated agent was injected intracamerally after aspiration of the same volume of aqueous humor. Ten minutes after injection, phacoemulsification was performed. After surgery began, the isoflurane concentration was adjusted according to heart rate and mean arterial blood pressure. Pain scores were recorded before surgery and at 0.5, 1, 1.5, 2, 2.5, 3, 3.5, 4, 6, 8, 16, and 24 hours after extubation. Isoflurane requirements were significantly higher in the BSS group than in the lidocaine group. Mean +/- SD time to administration of supplementary analgesia was significantly shorter in the BSS group (1.4 +/- 1.2 hours) than in the lidocaine group (4.9 +/- 1.2 hours). Intracameral lidocaine injection had significant analgesic effects in dogs undergoing cataract surgery. Results of this study suggest the value of intracameral lidocaine injection as an analgesic for intraocular surgery in dogs.

Evaluation of the mydriatic effect of intracameral lidocaine hydrochloride injection in eyes of clinically normal dogs

OBJECTIVE-To evaluate the mydriatic effect of intracameral injection of preservative-free 1% and 2% lidocaine hydrochloride solutions and determine the onset and duration of mydriasis according to the concentration and volume of lidocaine administered in healthy dogs. ANIMALS-5 healthy adult Beagles weighing 7 to 10 kg, with no apparent ocular disease. PROCEDURES-A double-blind randomized 9-session crossover trial was designed. Both eyes were assigned to 9 treatments with a minimum 7-day washout period between treatments: 0.1, 0.2, and 0.3 mL of 2% lidocaine solution; 0.1, 0.2, and 0.3 mL of 1% lidocaine solution; and 0.1, 0.2, and 0.3 mL of balanced salt solution. Dogs were anesthetized, and the allocated treatment was injected intracamerally after aspiration of the same volume of aqueous humor from the anterior chamber of each eye. Two perpendicular pupil diameters were measured. Intraocular pressure, heart rate, respiratory rate, ECG readings, and end-tidal partial pressure of CO(2) were monitored. RESULTS-Intracameral injection of 1% or 2% lidocaine solutions in volumes of 0.1 to 0.3 mL induced a significant degree of mydriasis, and the effect was maintained for 74 to 142 minutes. Lidocaine injection had no significant effect on intraocular pressure, heart rate, respiratory rate, ECG readings, or end-tidal partial pressure of CO(2). CONCLUSIONS AND CLINICAL RELEVANCE-Intracameral lidocaine injection in healthy dogs induced mydriasis, the timing of which was affected by concentration and volume of lidocaine. This technique could serve as an alternative to topically administered mydriatics for intraocular surgery in dogs.

Viscoanaesthesia in cataract surgery: a prospective, randomized clinical trial

We aimed to compare viscoanaesthesia (VisThesia) with intracameral lidocaine in cataract surgery carried out under topical anaesthesia. In this prospective study 98 patients were randomly assigned to receive VisThesia (group 1, n = 49) or 0.5 cc of 1% unpreserved lidocaine (group 2, n = 49). All surgery was carried out by one surgeon using clear corneal technique. Pachymetry, the status of the cornea and anterior chamber, and intraocular pressure (IOP) were checked pre- and postoperatively. Mean pain scores were 0.12 (maximum: 3) in group 1 and 0.37 in group 2; the difference between the groups was not statistically significant (95% confidence interval [CI] 0.003-0.487; p = 0.05). A total of 48 patients in group 1 (98%) and 49 in group 2 (100%) reported no discomfort or only mild discomfort. No significant differences in flare and cells in the anterior chamber or IOP were found between the two study groups. There was a significantly greater frequency of corneal oedema in group 1 (p = 0.001). Postoperative central corneal thickness values were also significantly higher in group 1 (95% CI 11.64-57.24; p = 0.003). Results suggest that viscoanaesthesia provides a level of comfort during cataract surgery under topical anaesthesia similar to that facilitated by intracameral lidocaine. However, patients who are given viscoanaesthesia may have increased risk for postoperative corneal oedema.

Pupil dilation with intracameral lidocaine during phacoemulsification: Benefits for the patient and surgeon

Topical and/or intracameral administration of anticholinergic and/or sympathomimetic mydriatic agents which are usually used for pupillary dilation during cataract surgery, have some disadvantages such as slow onset of dilation and adverse ocular and systemic effects. We evaluated intracameral injection of preservative-free 1% lidocaine without using any preoperative or intraoperative mydriatics to induce pupil dilation in 31 consecutive eyes scheduled for phacoemulsification cataract extraction and intraocular lens implantation. Pupil diameter was measured before and 90 sec after intracameral lidocaine injection. After intracameral lidocaine injection, the mean pupil diameter was significantly greater than the baseline measurement (P< 0.001). No additional mydriatics were needed up to the end of the operations. Intracameral preservative-free lidocaine 1% has a rapid and effective mydriasis that could be a safe alternative to topical and intracameral mydriatics in phacoemulsification.

Inadvertent Ocular Perforation during Lid Anesthesia for Hordeolum Removal

PurposeOcular perforation during lid anesthesia is rarely reported. We describe here a case of inadvertent corneal perforation and traumatic cataract that occurred during lid anesthesia in a procedure for hordeolum removal.MethodsA 33-year-old woman presented with a sudden visual loss of her left eye. She had undergone hordeolum removal the day before at a local clinic. On ophthalmologic examination, the cornea was perforated and the lens cortex was extruded into the anterior chamber. After cataract removal and IOL implantation, antibiotics were injected into the vitreous.ResultsHer final visual acuity of the left eye was 20/20. Postoperative specular microscopic examination revealed a normal-range endothelial cell count, coefficient of variation, and hexagonality despite the intracameral lidocaine injection.ConclusionsAnesthetic injection of an infected lid should be done with great caution. Although there are possibilities of corneal endothelial toxicity and endophthalmitis in case of intracameral lidocaine injection through the infected lid, yet proper management may save the patient's vision without complications.

Intracameral injection of lidocaine and carbachol

In their article about the effect of intracameral injection of lidocaine and carbachol on the rabbit corneal endothelium, Liou and coauthors1 concluded that lidocaine 1% and carbachol 0.01% did not produce morphologic and functional changes in the corneal endothelial cells of rabbit. There are, however, a few issues worth discussing. First, the rabbit is undoubtedly the most commonly used animal model for studying drug toxicities on the corneal endothelium in vivo. However, this animal model has a major drawback. Unlike the corneal endothelial cells in humans, which have very limited regenerative capacity, corneal endothelial cells in rabbits regenerate rapidly and completely in response to minor to moderate injury.2 Second, it has been shown that a corneal endothelial injury may not become evident (even by very sensitive methods such as histology and terminal deoxynucleotidyl transferase deoxy-UTP-nick end labeling techniques) in the first few hours after injury,3 while the rabbit corneal thickness, which is a reflection of corneal endothelial function, may return to normal within a week.2 Therefore, the timing of serial investigatory measurements will be of utmost importance if one does not wish to miss the window period of endothelial cell injury. In Liou and coauthors' study,1 corneal endothelial cell count and corneal thickness were measured 2 hours, 1 week, and 1 month after the injection of drugs. Although all readings were within normal range, corneal endothelial injury, if present, could well be missed during the period between 2 hours and 1 week. Moreover, the alizarin red and trypan blue staining as well as scanning electron microscopy (SEM), which are much more sensitive than corneal thickness and cell count measurement in detecting endothelial cell injury, were done 1 month after the injection only. These investigations were unlikely to be revealing because the injured endothelial cells would have regenerated completely and could not be distinguished from noninjured cells at that time.2 If the rabbit is to be used as an animal model for testing drug toxicities in vivo, we would suggest at least 4 sets, if not more, of investigations be done—the first few hours, 1 to 2 days, 1 week, and 1 month after intracameral injection.4,5 Ideally, more sensitive investigatory methods such as histological staining and SEM would be used at each investigation. This may require sacrifice of animals with enucleation of their eyes for investigation at different stages throughout the experiment. Finally, we would like to commend the authors for their valuable work on this issue and hope that our suggestions will broaden the discussion. Alex H. Fan MBBS Arthur C.K. Cheng MRCSEd Srinivas K. Rao FRCSEd Li-Jia Chen Dennis S.C. Lam MD, FRCOphth Hong Kong, China

Lidocaine Gel versus Combined Topical Anesthesia Using Bupivacaine, Oxybuprocaine and Diclofenac Eyedrops in Cataract Surgery

Purpose: To assess the safety and efficacy of two topical anesthesia regimes for cataract surgery. Methods: 21 patients received a combination of 4 times bupivacaine 0.5, oxybuprocaine and diclofenac eyedrops, 18 patients were given a single topical application of lidocaine gel 2%. A single intracameral injection of lidocaine 1% was administered to all subjects. Results: The extent to which the surgeon was bothered by patient motility was graded as low in about two thirds of all procedures. Patients reported lower intraoperative pain levels with a single application of lidocaine gel supplemented with intracameral lidocaine than with a fourfold application of the combination topical anesthesia plus intracameral anesthesia. Conclusions: A single application of lidocaine gel 2% combined with intracameral anesthesia provides at least as good analgesia than multiple administration of combined topical anesthesia supplemented with intracameral anesthesia and is equally safe.

Effect of intracameral injection of lidocaine and carbachol on the rabbit corneal endothelium

Purpose: To determine the effect of intracameral injection of preservative-free lidocaine 1% and carbachol 0.01% on corneal endothelial cells of rabbits. Setting: Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan. Methods: Forty eyes of 20 New Zealand White rabbits were divided into 2 equal groups. In the first group, 1 eye was injected with 0.02 mL of preservative-free lidocaine 1% and the fellow eye was injected with 0.02 mL of normal saline as a control. In the second group, 1 eye was injected with 0.02 mL of carbachol 0.01% and the fellow eye was injected with 0.02 mL of normal saline. Specular microscopy was used to evaluate corneal endothelial cell loss and corneal thickness 1 week and 1 month postinjection. For morphologic studies, corneal buttons were excised and stained with alizarin red with trypan blue. Scanning electron microscopy (SEM) examination was performed. Results: Specular microscopy revealed no significant endothelial cell loss and normal endothelial thickness with the intracameral injection of preservative-free lidocaine 1% and carbachol 0.01% compared with the control eye. Alizarin red with trypan blue stain and SEM examinations revealed smooth, distinct, and intact intercellular borders and normal viability of corneal endothelial cells in both groups. Conclusions: Intracameral injections of preservative-free lidocaine 1% and carbachol 0.01% do not produce morphologic and functional changes in the corneal endothelial cells of rabbits.

Author reply

We appreciate Dr. Sodhi and associates comments on our study. Dr Sohdi's main concern centers on the use of lidocaine for phakic trabeculectomies. Specifically, the risk of cataract formation and peripheral iris crowding during intracameral lidocaine injection was raised. We would like to address these points.

Pupil dilatation with intracameral 1% lidocaine during glaucoma filtering surgery

In the article titled by Lee and associates (Am J Ophthalmol 2003;136:201–203), the authors used a combination of topical tetracaine along with nonpreserved intracameral lidocaine (1%) in the anterior chamber to produce ocular anesthesia in their glaucoma patients. The topical tetracaine anesthetizes the ocular surface while the intracameral injection of lidocaine anesthetizes the pain sensitive iris tissue. The authors performed trabeculectomy in 25 phakic patients under this anesthesia. We infer that this form of combination anesthesia was used by the authors to circumvent the disadvantages of procedures like peribulbar or retrobulbar injection which are more painful, lengthy, need a larger dose of anesthetic agent, and have an added risk of perforating the globe. Our main consideration is the surgery, that is, trabeculectomy in phakic patients for which this form of anesthesia was used by the authors. We feel that any form of manipulation in the anterior chamber including a needle perforation should be avoided in phakic patients. This has an inherent risk of damaging the anterior lens capsule and accelerating the formation of lens opacity. Our second concern is that after pupillary dilation (as with intracameral lidocaine), the iris tends to crowd in the periphery. Hence, the surgeon tends to snip a larger piece of iris while doing peripheral iridectomy following trabecular excision. That is why constriction of pupils is usually advised in patients who have to undergo trabeculectomy. For this, pilocarpine is used both topically (in chronic angle closure patients) and in the form of an intracameral injection. We feel that such combination anesthesia would have been more appropriate if the surgeons had to do cataract extraction along with glaucoma surgery. First, in this combined procedure there is no danger from any sort of manipulation in the anterior chamber. Second, at the conclusion of surgery, an appropriate size periphery iridectomy can be done after constricting pupil with inracameral pilocarpine following intraocular lens insertion. Author replyAmerican Journal of OphthalmologyVol. 137Issue 4Preview Full-Text PDF

Systemic levels of lidocaine after intracameral injection during cataract surgery

Purpose To evaluate the systemic concentrations of lidocaine after intracameral injection of a 1% solution during cataract surgery and the safety of this application mode. Setting Department of Ophthalmology, Medical University of Lübeck, Lübeck, Germany. Methods This prospective study included 10 patients who had phacoemulsification and posterior chamber lens implantation with a self-sealing scleral tunnel incision. Topical anesthesia was achieved using cocaine 10% eyedrops combined with 0.5mL of unpreserved lidocaine 1% injected into the anterior chamber. Blood samples were taken from all patients at predetermined intervals before and during the procedure. Consecutive analysis for lidocaine was performed with gas chromatography. Results In all samples, serum lidocaine concentrations were below a minimum detectable level of 100 ng/mL. No local or systemic intraoperative or postoperative complications were noted. Conclusions Intracameral injection of 0.5 mL lidocaine 1% revealed no systemic therapeutic concentrations. In patients in whom other forms of needle-delivered local anesthesia are contraindicated, intracameral injection of lidocaine should be considered to enhance topical anesthesia.

Topical anesthesia using lidocaine gel for cataract surgery

Purpose To assess the safety and efficacy of topical anesthesia using lidocaine gel in cataract surgery. Setting Department of Ophthalmology, Meir Hospital, Sapir Medical Center, Kfar-Saba, Israel. Methods One hundred cataract procedures (48 manual extracapsular cataract extraction [ECCE] and 52 phacoemulsification) were performed using lidocaine 2% gel as the sole anesthetic agent. The gel was applied 3 to 5 times prior to surgery. Intraoperative and postoperative data were recorded, and patients were asked to grade the pain on a scale of 0 (no pain) to 10 (unbearable pain). Results Sixty-two percent of patients having manual ECCE and 74% having phacoemulsification reported no pain during surgery (score 0). The mean pain score in the manual ECCE group was 0.99 ± 1.64 (SD); 3 patients required an additional intracameral lidocaine injection. The mean score in the phacoemulsification group was 0.72 ± 1.47; no patient required additional anesthesia. Conclusions Topical application using lidocaine 2% gel is safe and highly effective, especially in clear corneal phacoemulsification. The gel also provides prolonged lubrication, further facilitating surgery.