Supplementary intracameral lidocaine for phacoemulsification under topical anesthesia

Topic: We consider a meta-analysis of randomized controlled trials (RCTs) comparing topical anesthesia alone with topical and intracameral anesthesia for phacoemulsification. Clinical Relevance: Topical anesthesia has become an increasingly popular option for day-case cataract surgery. Many surgeons now use supplementary intraoperative intracameral lidocaine, but the evidence base for the supplementary use of intracameral anaesthetic during cataract surgery has never been reviewed systematically. Methods/Literature Reviewed. The primary objective is to compare intraoperative pain for phacoemulsifications under topical anesthesia with and without intracameral anesthesia. The secondary objectives are to assess both adverse effects and complications attributable to choice of anesthesia and the need for additional anesthesia during surgery. Searches were made from the Cochrane Central Register of Controlled Trials, Medline, Excerpta Medica database, and Latin American and Caribbean Health Science Information Database up to and including June 8, 2006. Results: Eight RCTs, recruiting a total of 1281 patients, were identified. Our data comparison showed significantly lower intraoperative pain perception in patient groups using supplementary intracameral lidocaine. No significant difference in intraoperative adverse events, corneal toxicity, or the need for supplemental anesthesia was identified. Conclusion: Intraoperative pain during cataract surgery under topical anaesthetic is reduced by intracameral lidocaine. Possible adverse effects of intracameral liclocaine cannot be excluded due to significant heterogeneity in outcome measures between different RCTs. Although a statistically significant reduction in intraoperative pain has been demonstrated, it is not yet possible to recommend this additional intervention without reservations.