Safety and efficacy of topical anesthesia combined with a lower concentration of intracameral lidocaine in phacoemulsification: paired human eye study.
OBJECTIVE
To assess the safety and efficacy of phacoemulsification under a topical anesthesia combined with intracameral lidocaine 0.5%.


METHODS
Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan, China.


METHODS
A prospective randomized double-blind study was designed in which patients had phacoemulsification performed under topical anesthesia (4 drops of nonpreserved lidocaine 2%) with 0.15 mL intracameral placebo (balanced salt solution) in 1 eye (Group 1) and topical anesthesia with intracameral nonpreserved lidocaine 0.5% in the other eye (Group 2). Endothelial changes, including cell density, coefficient variation of cell size, and percentage of hexagonal cells, were measured by noncontact specular microscopy. Preoperative and postoperative best corrected visual acuity was also documented. The degree of pain throughout surgery was ranked on a 10-point visual analog pain scale.


RESULTS
Thirty-three patients were recruited. There was no significant difference in preoperative and postoperative mean endothelial parameters between the 2 groups. Furthermore, mean endothelial cell loss was similar. Mild or no pain (score 0 to 1) was reported by 48.5% in Group 1 and 90.9% in Group 2. Patients reported less pain with combined topical and intracameral lidocaine anesthesia (P = .001, Mann-Whitney test). Vision was significantly improved in both groups. However, 1 patient in Group A developed vitreous loss as a result of involuntary eye movement.


CONCLUSIONS
Combining topical anesthesia with intracameral lidocaine 0.5% [corrected] anesthesia was safe and effective in phacoemulsification with intraocular lens implantation.
Chuang
Lan-Hsin
LH
Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, and Chang Gung University College of Medicine, Taiwan, China.
Yeung
Ling
L
Ku
Wan-Chen
WC
Yang
Ko-Jen
KJ
Lai
Chi-Chun
CC
D000368:Aged; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D000869:Anterior Eye Segment / Q000187:drug effects; D002452:Cell Count; D004311:Double-Blind Method; D004728:Endothelium, Corneal / Q000473:pathology; D005260:Female; D006801:Humans; D019654:Lens Implantation, Intraocular / Q000379:methods; D008012:Lidocaine / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008866:Microsurgery / Q000379:methods; D010147:Pain Measurement; D018918:Phacoemulsification / Q000379:methods*; D011446:Prospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity
D000779:Anesthetics, Local; D008012:Lidocaine