Corneal endothelial safety of intracameral preservative-free 1% xylocaine.
OBJECTIVE
To evaluate the effect of intracameral preservative-free 1% xylocaine on the corneal endothelium as an adjuvant to topical anaesthesia during phacoemulsification and Acrysof foldable IOL implantation.


METHODS
This is a prospective, controlled, randomised, double-masked study. 106 patients with soft to moderately dense (Grade 1-3) senile cataract and corneal endothelial cell density of >1500/mm2 were randomised to the xylocaine group (n=53) and control group(n=53). Central endothelial specular microscopy and ultrasound corneal pachymetry were performed preoperatively. On the first postoperative day the eyes were evaluated for corneal oedema and Descemet's folds. Ultrasound corneal pachymetry was performed at 1, 3 and 12 months. Specular microscopy was performed at 3 and 12 months. Cell loss was expressed as a percentage of preoperative cell density. Six patients could not complete one year follow-up. Chi-square and paired t test (2 tail) statistical tests were applied for analysis.


RESULTS
Four (7.54%) patients in the xylocaine group and 5 (9.43%) in the control group had a few Descemet's folds associated with mild central stromal oedema. Corneal thickness increased from 549.3micro +/- 37.2micro to 555.5micro +/- 36.5micro in the xylocaine group and from 553.1micro +/- 36.2micro to 559.3micro +/- 40.5micro in the control group at the one-month postoperative visit. Thickness returned to the preoperative level in xylocaine group 549.6micro +/- 34.5micro and control group 554.7micro +/- 41.1micro at three months. (P=0.484) The percentage of cell loss was 4.47 +/- 2.53% in the xylocaine group and 4.49 +/- 3.09% in the control group at one year. (P=0.97)


CONCLUSIONS
Intracameral preservative-free 1% xylocaine does not appear to affect corneal endothelium adversely during phacoemulsification.
Iladevi Cataract & IOL Research Centre, Ahmedabad, India.
Alpesh R
AR
Shah
Rasesh P
RP
Diwan
Abhay R
AR
Vasavada
Manzoor Qadir
MQ
Keng
D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D002452:Cell Count; D015715:Corneal Edema / Q000139:chemically induced / Q000473:pathology; D003319:Corneal Stroma / Q000187:drug effects / Q000473:pathology; D019781:Corneal Topography; D004311:Double-Blind Method; D004728:Endothelium, Corneal / Q000187:drug effects* / Q000473:pathology; D005260:Female; D006801:Humans; D019654:Lens Implantation, Intraocular; D008012:Lidocaine / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification; D011310:Preservatives, Pharmaceutical; D011446:Prospective Studies; D012449:Safety
D000779:Anesthetics, Local; D011310:Preservatives, Pharmaceutical; D008012:Lidocaine