Graefes Arch Clin Exp Ophthalmol (2010) 248:149–150 DOI 10.1007/s00417-009-1194-3
LETTER TO THE EDITOR
Lidocaine 2% jelly versus lidocaine 2%-sodium hyaluronate 0.3% drops in phacoemulsification surgery Irini P. Chatziralli & Leonidas Papazisis & Theodoros N. Sergentanis
Received: 23 July 2009 / Revised: 23 August 2009 / Accepted: 31 August 2009 / Published online: 24 September 2009 # Springer-Verlag 2009
Dear Editor, Lidocaine jelly has been used as a topical anesthetic in cataract surgery with satisfactory results [1, 2]. Its advantages, such as the avoidance of repeated corneal irrigation [3], and its disadvantages, such as the difficulty in applying the appropriate amount of lidocaine jelly [4], have occasionally been discussed in the literature. Interestingly enough, the preparations of lidocaine per se may present differences with respect to their actions or side-effects [5]. This randomized controlled trial compares two distinct modes of topical lidocaine administration in terms of efficacy (pain control) and conjunctival redness: (i) Lidocaine 2% jelly (Xylocaine, AstraZeneca), standardized amount of 1 ml (LJ group, n=73) and (ii) Lidocaine 2%-sodium hyaluronate 0.3% (Visthesia, Zeiss), 0.3 ml, i.e., one ampoule, (LSH group, n=77). The topical anesthetic was administered 10 min prior to the beginning of phacoemulsification (Alcon Series 20000 Legacy). The need for additional topical anesthetic was recorded in both groups. All procedures were performed by the same surgeon. No intracameral component was administered. After the completion of surgery, patients were asked to rate their pain on a visual analog scale (VAS, range: 0–10). In addition, the presence of conjunctival redness was independently assessed by two ophthalmologists (IPC and
I. P. Chatziralli (*) : L. Papazisis Department of Ophthalmology, Veroia General Hospital, Greece, 28, Papanastasiou Street, Athens, 17342, Greece e-mail:
[email protected] T. N. Sergentanis School of Medicine, National University of Athens, Athens, Greece
LP) 10 min after the administration of topical anesthesia (and evidently prior to the beginning of surgery). Statistical analysis was performed with STATA 8.0 statistical software (StataCorp, College Station, TX, USA). This study is in accordance with the Declaration of Helsinki and has been approved by the local ethics committee. Written informed consent was obtained from all patients. The authors declare no conflict of interest. The evaluated parameters, along with their statistical significance are presented in Table 1. The LSH group exhibited less intense pain than patients treated with lidocaine 2%. Interestingly enough, the percentage of redness was significantly higher in patients treated with LJ. Neither VAS score nor conjunctival redness was associated with gender or age in the treatment groups. The results remained practically unchanged after the exclusion of patients needing additional administration of topical anesthetic. The superiority of the LSH group in terms of pain was statistically significant; nevertheless, the magnitude of the difference in VAS ratings was small and both groups scored below 1/10 on average. Consequently, both protocols seem to guarantee a well-tolerated phacoemulsification procedure. In conclusion, the most striking finding of this study is the high incidence of conjunctival redness after the administration of topical LJ. This may imply a mild, temporary irritating effect of some constituents of the jelly, which has not been especially designed for the eye. Indeed, in the Product Monograph of a commonly used LJ (Xylocaine, AstraZeneca) [6], there is a clear warning to “avoid contact with eyes”; however, the use of LJ seems fairly established [1–4]. It should be stressed that the clinical significance of this effect on the conjunctiva remains rather elusive, as no major adverse general or eye-related outcomes became evident in our study. In any case, biochemical studies aiming
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Graefes Arch Clin Exp Ophthalmol (2010) 248:149–150
Table 1 Evaluated parameters in the two study groups Lidocaine 2%-sodium hyaluronate 0.3% Categorical variables Need for additional administration Redness (%) Continuous variables Pain (VAS score) F
P-value derived from Fisher’s exact test,
Percentage (frequency) 2.6% (2/77) 1.3% (1/77) Mean ± SD 0.29±0.82 MWW
Lidocaine 2% jelly group
P-value
1.4% (1/73) 24.7% (18/73)
1.0F
