Intracameral anesthesia - A report by the American Academy of Ophthalmology

Objective: This document describes the technique of intracameral anesthesia and examines the available evidence to address questions about its effecti veness, possible corneal endothelial and retinal toxicity, and the optimal and maximal dose. Methods: A literature search conducted for the years 1968 to 2000 retrieved over 180 citations that matched the search criteria. Panel members and a m ethodologist reviewed this information, and it was evaluated for the qualit y of the evidence presented. Results: Some studies report effectiveness of intracameral anesthesia while others report no effect. In those studies showing an effect, levels of pai n in the groups that were compared were low. Short-term studies seem to ind icate that preservative (methylparaben)-free lidocaine 1% is well tolerated by the corneal endothelium but that higher concentrations of lidocaine are toxic. There is some evidence of electroretinogram changes after exposure to lidocaine or bupivacaine. Conclusions: The ideal timing and placement of intracameral anesthesia has not been determined. Because topical anesthesia alone is effective, surgeon s may elect to use intracameral anesthesia for incremental pain control in patients who cannot be adequately managed with topical alone. Appropriate p atient selection is important when using this method of anesthesia. While s hort-term studies seem to indicate safety, long-term effects are unknown. P atient preferences for anesthesia are not well studied.