Corneal endothelial toxicity of topical anesthesia.
OBJECTIVE
To determine the relative corneal endothelial toxicities of the following topical anesthetic agents: bupivacaine HCl 0.75%, unpreserved lidocaine HCl 4%, proparacaine HCl 0.5%, and tetracaine HCl 0.5%.


METHODS
The experiment was conducted using pigmented rabbits. Approximately nine animals each were randomly assigned to eight groups. Right eyes received injections of 0.2 ml of one of the four anesthetic agents at one of two concentrations and left eyes received injections of 0.2 ml of balanced salt solution. Corneal thickness and clarity were measured before surgery and on postoperative days 1, 3, and 7.


RESULTS
A statistically significant increase (P < 0.05) in corneal thickness and opacification over preoperative measurements was noted with injections of bupivacaine, lidocaine, and proparacaine, controlling for changes occurring in control eyes from surgery alone. Proparacaine was statistically more toxic than were the others. The toxicity of tetracaine was statistically indistinguishable from balanced salt solution, although mild toxicity was evident clinically. Injection of 1:10 dilutions of the same anesthetic agents failed to produce a statistically significant increase in corneal thickness or opacification on any postoperative examination.


CONCLUSIONS
Anterior chamber injection of bupivacaine HCl 0.75%, unpreserved lidocaine HCl 4%, and proparacaine HCl 0.5% produces corneal thickening and opacification that is clinically and statistically significant. Tetracaine HCl 0.5% injection produces corneal thickening and opacification that is clinically apparent in some eyes but statistically insignificant. Ophthalmic surgeons should be aware of the potential for endothelial cell injury if anesthetic agents enter or are injected into the eye during cataract surgery in the concentrations supplied commercially.
Judge
A J
AJ
Department of Ophthalmology, UCLA School of Medicine, USA.
Najafi
K
K
Lee
D A
DA
Miller
K M
KM
D000287:Administration, Topical; D000772:Anesthesia, Local / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000633:toxicity*; D000818:Animals; D000867:Anterior Chamber / Q000187:drug effects / Q000473:pathology; D002045:Bupivacaine / Q000633:toxicity; D015715:Corneal Edema / Q000139:chemically induced / Q000473:pathology; D003318:Corneal Opacity / Q000139:chemically induced / Q000473:pathology; D004728:Endothelium, Corneal / Q000187:drug effects* / Q000473:pathology; D007267:Injections; D008012:Lidocaine / Q000633:toxicity; D009883:Ophthalmic Solutions; D011430:Propoxycaine / Q000633:toxicity; D011817:Rabbits; D013748:Tetracaine / Q000633:toxicity
D000779:Anesthetics, Local; D009883:Ophthalmic Solutions; D013748:Tetracaine; D008012:Lidocaine; C005717:proxymetacaine; D011430:Propoxycaine; D002045:Bupivacaine