title: Safety and efficacy of two ocular anesthetic methods for phacoemulsification: topical anesthesia and viscoanesthesia (VisThesia).
abstract: OBJECTIVE
  VisThesia is a new ophthalmic viscosurgical device (OVD) which has 1% lidocaine combined with 1.5% sodium hyaluronate. This is a prospective evaluation of the safety and efficacy of VisThesia used in association with phacoemulsification.
  
  
  METHODS
  A total of 114 eyes were divided into two groups. Fifty-nine eyes were treated with tetracaine + oxybuprocaine topical anesthesia and DuoVisc OVD and 55 eyes were treated with VisThesia, for use as both topical anesthetic and OVD. Endothelial cell counts were measured at 30 days postoperatively and compared to preoperative baseline values. Pain and discomfort was subjectively evaluated by patients using a visual analog pain scale (0-10).
  
  
  RESULTS
  All surgeries were uneventful with no intraoperative or immediate postoperative complications. Patients receiving topical anesthesia had a mean pain score of 1.1+/-6.8 compared to a mean score of 1.3+/-4.6 for patients receiving VisThesia (p=0.59). Postoperatively, endothelial cell loss at 1 month was greater for patients receiving VisThesia (20.32%+/-43.75) than for those receiving the topical anesthetic (8.8%+/-59.6; p<0.0001).
  
  
  CONCLUSIONS
  The results from the visual analog pain scale were comparable between groups, showing that VisThesia provides similar pain relief to topical anesthesia. Specular microscopy performed at 30 days postoperatively showed a significantly greater loss of endothelial cells with the use of VisThesia, suggesting that the 1% lidocaine concentration used in VisThesia may be toxic to corneal endothelial cells.
authors.affiliation: Department of Ophthalmology, Regional Hospital Center Bon-Secours of Metz, 1 place Ph. de Vigneulles, 57000 Metz, France. peronejm@aol.com
authors.forename: J M
authors.initials: JM
authors.lastname: Perone
authors.forename: A
authors.initials: A
authors.lastname: Popovici
authors.forename: R
authors.initials: R
authors.lastname: Ouled-Moussa
authors.forename: O
authors.initials: O
authors.lastname: Herasymyuk
authors.forename: S
authors.initials: S
authors.lastname: Reynders
mesh_terms: D000368:Aged; D000772:Anesthesia, Local / Q000379:methods*; D019162:Anesthetics, Combined / Q000008:administration & dosage* / Q000009:adverse effects; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D002452:Cell Count; D004728:Endothelium, Corneal / Q000473:pathology; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage* / Q000009:adverse effects; D019654:Lens Implantation, Intraocular; D008012:Lidocaine / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D010147:Pain Measurement; D017060:Patient Satisfaction; D018918:Phacoemulsification; D011343:Procaine / Q000008:administration & dosage / Q000031:analogs & derivatives; D011446:Prospective Studies; D013748:Tetracaine / Q000008:administration & dosage
chemical_list: D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D013748:Tetracaine; D011343:Procaine; D006820:Hyaluronic Acid; D008012:Lidocaine; C005298:benoxinate