Efficacy and safety of intravenous injection of lidocaine in the treatment of acute primary angle-closure glaucoma: a pilot study.
OBJECTIVE
To study the safety and effectiveness of a combination of both intravenous injection of lidocaine and intraocular pressure-lowering medications, in the intraocular pressure control and relief of symptoms of refractory acute primary angle-closure glaucoma (PACG).


METHODS
Five consecutive patients with their first attack of acute PACG, with intraocular pressure > or = 45 mmHg and a failure to release from the attack under antiglaucomatous medications for 4 hours, were recruited into the study. On presentation, each patient received topical pilocarpine and timolol, and systemic acetazolamide and mannitol as primary treatment. Then the patients accepted 2% lidocaine by intravenous injection at dose of 0.8 mg/kg in concert with antiglaucomatous medications. The intraocular pressures after intravenous injection at 30 minutes, and then at 1, 2, 4, 12, and 24 hours, were documented by applanation tonometry. Symptoms, visual acuity, intraocular pressure, corneal edema, angle status on gonioscopy, pupillary size, and reaction were also measured.


RESULTS
Six eyes of five patients seen with acute PACG were recruited. The mean intraocular pressure was reduced from 50.83 +/- 5.34 mmHg to 39.5 +/- 3.45 mmHg at 30 minutes after intravenous injection, and then to 33.3 +/- 3.56 mmHg at 1 hour, and 24.55 +/- 5.09 mmHg at 2 hours after intravenous injection. The mean intraocular pressure was less than 21 mmHg at 4 hours and beyond. There was instant symptomatic relief for all patients. No complications were encountered.


CONCLUSIONS
From this preliminary study, intravenous injection of lidocaine seems to be safe and effective in controlling intraocular pressure and eliminating symptoms in acute PACG. But the exact efficacy and safety need further investigation in large case studies.
Jin
Xiuming
X
School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical College, Wenzhou, Zhejiang 325003, People's Republic of China.
Xue
Anquan
A
Zhao
Yune
Y
Qin
Qin
Q
Dong
Xiang-Da Eric
XD
Qu
Jia
J
D000208:Acute Disease; D000368:Aged; D018686:Anesthetics, Intravenous / Q000008:administration & dosage* / Q000009:adverse effects; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000009:adverse effects; D001794:Blood Pressure; D004359:Drug Therapy, Combination; D005260:Female; D015812:Glaucoma, Angle-Closure / Q000188:drug therapy*; D006068:Gonioscopy; D006339:Heart Rate; D006801:Humans; D007275:Injections, Intravenous; D007429:Intraocular Pressure / Q000187:drug effects*; D008012:Lidocaine / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D014065:Tonometry, Ocular; D016896:Treatment Outcome
D018686:Anesthetics, Intravenous; D000959:Antihypertensive Agents; D008012:Lidocaine