Pain, photophobia, and retinal and optic nerve function after phacoemulsification with intracameral lidocaine

Objective: To evaluate differences in pain, photophobia, retinal and optic nerve function in test eyes given intracameral lidocaine compared with cont rol eyes given intracameral saline after phacoemulsification under topical anesthesia. Design: Prospective paired-eye intervention study with random treatment all ocation. Participants: Thirty eyes of 15 patients underwent cataract surgery in both eyes under topical anesthesia. Intervention: The first eye of each patient was randomly assigned to either 0.5 ml preservative-free 2% intracameral lidocaine or 0.5 ml of intracamer al sterile saline. Within 5 months, the second eye automatically received i ntracameral saline if the first eye received intracameral lidocaine or vice versa. Main Outcome Measures. The duration of surgery was recorded. Immediately af ter surgery, each patient was asked to evaluate the degree of pain and phot ophobia experienced during surgery using a nominal scale. In addition, in f ive patients, electroretinography (ERG) and visual evoked response (VER) we re performed within I week before surgery, immediately after surgery, and 1 day after surgery. Amplitudes and latencies were calculated. Results: There was no difference in the duration of surgery comparing test eyes given intracameral lidocaine with control eyes given. sterile saline ( P=0.81). There was no significant difference in the level of pain reported when. comparing test eyes given intracameral lidocaine with control, eyes ( P=1.00). None of the, patients reported any significant difference in photo phobia between their two eyes (P=1.00). When comparing ERG measurements, te st eyes, given intracameral lidocaine did not show any significant decrease in ERG amplitudes, or prolonged latencies compared with control eyes. When comparing VER measurements, test eyes given intracameral lidocaine did not show any increase in P1 latencies compared with control eyes (P=0.31). Whe n evaluating all postoperative ERG results 1 day after surgery, there was a suggestion of improved cone function. Conclusions: Although intracameral lidocaine does not depress retinal or op tic nerve function, the addition: of intracameral lidocaine to topical anes thesia during phacoemulsification does not significantly reduce intraoperat ive pain or photophobia. Ophthalmology 2001;108:2018-2025 (C) 2001 by the A merican Academy of Ophthalmology.