Topical tetracaine versus topical tetracaine plus intracameral lidocaine for cataract surgery

Purpose: To compare topical tetracaine 0.5% alone and with intracameral lid ocaine 1% as a local anesthetic agent in phacoemulsification with intraocul ar lens (IOL) implantation. Setting: The Toronto Hospital-Western Division, Toronto, Canada, Methods: Fifty-nine consecutive patients (60 eyes) having phacoemulsificati on with :implantation of a foldable acrylic IOL (AcrySof) were randomized i nto 1 of 2 groups: The intracameral balanced salt solution (BSS(R)) group r eceived topical tetracaine 0.5% plus intracameral BSS; the intracameral lid ocaine group received topical tetracaine 0.5% with preservative-free intrac ameral lidocaine 1%, The patients' subjective experience of pain was measur ed at 4 points during surgery using a 4-point pain scale. Patient and surge on satisfaction with the anesthesia used was measured using a 5-point satis faction scale, Central endothelial cell counts were obtained preoperatively and 1 month postoperatively, Best corrected visual acuity (BCVA) was measu red preoperatively and 1 hour, 1 day, 1 week, and 1 month postoperatively. Results: The mean pain score after phacoemulsification was significantly hi gher in the intracameral BSS group than in the intracameral lidocaine group (0.63 +/- 0.7 [SD] and 0.23 +/- 0.4, respectively; P < .019), The mean pai n score at the end of surgery was also significantly higher in the intracam eral BSS group than in the 1 intracameral lidocaine group (0.60 +/- 0.6 and 0.21 +/- 0.4, respectively; P <.014). The surgeon satisfaction score was s ignificantly lower for the intracameral BSS group than for the intracameral lidocaine group (3.90 +/- 1.2 and 4.73 +/- 0.8, respectively; P <.0007). T here was no difference in patient satisfaction between the intracameral BSS and intracameral lidocaine groups (4.60 +/- 0.6 and 4.70 +/- 0.8). Endothe lial cell loss 1 month postoperatively was similar between the 2 groups (6. 1% +/- 8% and 6.7% +/- 6%). Ninety-seven percent of patients (29/30) in eac h group noted BCVA improvement from preoperatively. The rate oi potential v isual acuity recovery was similar in both groups. Conclusion: Topical tetracaine 0.5% with intracameral lidocaine was safe an d effective in patients having phacoemulsification with IOL implantation. T he advantage of using intracameral lidocaine 1% over a placebo was a signif icant decrease in the patients' subjective experience of pain and in the su rgeon's satisfaction with the anesthesia used. None of the other parameters measured in this study differed significantly between the 2 groups.