Evaluation of efficacy of intracameral lidocaine and tropicamide injection in manual small-incision cataract surgery: A prospective clinical study

Purpose: The study was conducted to evaluate efficacy of intracameral lidocaine hydrochloride 1% and tropicamide injection 0.02% for anaesthesia and mydriasis in manual small?incision cataract surgery (MSICS) and to report any adverse drug reaction. Methods: This was a randomized, prospective, observational study on 32 participants that took place from October 2021 to March 2022 (6 months). Patients between age group 40� year with nuclear sclerosis cataract and pupil diameter >6 mm in preoperative evaluation were included in the study. Patients with pseudoexfoliation, rigid pupil, senile miosis, history of uveitis, ocular trauma, recent ocular infections, with known allergy to tropicamide, all types of glaucoma were excluded from the study. Results: Thirty?two eyes with nuclear sclerosis cataract who underwent MSICS were studied. Fixed dose combination of 2 ml phenyl epinephrine (0.31%), tropicamide (0.02%), and lidocaine (1%) intracamerally was used for mydriasis and analgesia. More than 7 mm pupillary dilatation was achieved within 20 seconds of injection in 29 cases (90.6%). Mild pain and discomfort was noted in 12 cases (37.5%). Postoperative day 1 unaided visual acuity was in the range of 6/18�12 for all patients and grade 1 iritis was seen in 7 cases (21.8%) which was self?limiting. No adverse event like corneal decompensation or TASS were noted.Conclusion: Thus, Intracameral injection of mydriatic provides rapid and sustainable mydriasis and analgesia for manual SICS

Inadvertent Ocular Perforation during Lid Anesthesia for Hordeolum Removal

PURPOSE: Ocular perforation during lid anesthesia is rarely reported. We describe here a case of inadvertent corneal perforation and traumatic cataract that occurred during lid anesthesia in a procedure for hordeolum removal. METHODS: A 33-year-old woman presented with a sudden visual loss of her left eye. She had undergone hordeolum removal the day before at a local clinic. On ophthalmologic examination, the cornea was perforated and the lens cortex was extruded into the anterior chamber. After cataract removal and IOL implantation, antibiotics were injected into the vitreous. RESULTS: Her final visual acuity of the left eye was 20/20. Postoperative specular microscopic examination revealed a normal-range endothelial cell count, coefficient of variation, and hexagonality despite the intracameral lidocaine injection. CONCLUSIONS: Anesthetic injection of an infected lid should be done with great caution. Although there are possibilities of corneal endothelial toxicity and endophthalmitis in case of intracameral lidocaine injection through the infected lid, yet proper management may save the patient's vision without complications.

Efficacy of Intracameral Lidocaine During Phacoemulsification in Vitrectomized Eye

PURPOSE: This study was designed to evaluate the efficacy of intracameral lidocaine injection on patient' s pain relief during phacoemulsification in vitrectomized eyes and the influence on the corneal endothelial cells. METHODS: A prospective, double blind clinical trial was performed on 60 eyes of 60 patients who had undergone phacoemulsification from October 2000 to February 2001 at Busan PAIK Hospital. Thirty eyes had prior vitrectomy. Before surgery specular microscopic examination was performed. The patients were divided into vitrectomized and nonvitrectomized groups, and the lidocaine or placebo (BSS) was injected into the anterior chamber of 15 eyes each in two subgroups within each group. Pain was assessed using a visual analogue scale before, during and after operation. Endothelial cells were examinined at one week, one month, and three months after operation with a specular microscope. RESULTS: In vitrectomized patients, intracameral lidocaine injection resulted in significantly lower intraoperative pain score. There were no significant differences in morphological changes of endothelium between lidocaine and placebo groups. CONCLUSIONS: Intracameral lidocaine injection with topical anesthesia had significant effect in intraoperative pain relief during phacoemulsification in vitrectomized eyes. There was no significant effects on corneal endothelium. We conclude that intracameral anesthesia is safe and reduces intraoperative pain in vitrectomized eyes.