VisThesia™ is a new ophthalmic viscosurgical device (OVD) which has 1% lidocaine combined with 1.5% sodium hyaluronate. This is a prospective evaluation of the safety and efficacy of VisThesia™ used in association with phacoemulsification.
Methods
A total of 114 eyes were divided into two groups. Fifty-nine eyes were treated with tetracaine + oxybuprocaine topical anesthesia and DuoVisc® OVD and 55 eyes were treated with VisThesia™, for use as both topical anesthetic and OVD. Endothelial cell counts were measured at 30 days postoperatively and compared to preoperative baseline values. Pain and discomfort was subjectively evaluated by patients using a visual analog pain scale (0–10).
Results
All surgeries were uneventful with no intraoperative or immediate postoperative complications. Patients receiving topical anesthesia had a mean pain score of 1.1±6.8 compared to a mean score of 1.3±4.6 for patients receiving VisThesia™ (p=0.59). Postoperatively, endothelial cell loss at 1 month was greater for patients receiving VisThesia™ (20.32%±43.75) than for those receiving the topical anesthetic (8.8%±59.6; p<0.0001).
Conclusions
The results from the visual analog pain scale were comparable between groups, showing that VisThesia™ provides similar pain relief to topical anesthesia. Specular microscopy performed at 30 days postoperatively showed a significantly greater loss of endothelial cells with the use of VisThesia™, suggesting that the 1% lidocaine concentration used in VisThesia™ may be toxic to corneal endothelial cells. (Eur J Ophthalmol 2007; 17: 171–7)
LebuissonD.A., LimP., MaryJ.C., JolivetM.C.Anesthésie topique pour l'opération de la cataracte de l'adulte.J Fr Ophtalmol1996; 19: 181–9.
3.
ZehetmayerM., RadaxU., SkopikC.Topical versus peribulbar anesthesia in clear corneal cataract surgery.J Cataract Refract Surg1996; 22: 480–4.
4.
PatelB.C., ClinchT.A., BurnsT.A., SchomakerS.T., JessenR., CrandallA.S.Prospective evaluation of topical versus retrobulbar anesthesia: a converting surgeon's experience.J Cataract Refract Surg1998; 24: 853–60.
5.
JacobiP.C., DietleinT.S., JacobiF.K.A comparative study of topical vs retrobulbar anesthesia in complicated cataract surgery.Arch Ophthalmol2000; 118: 1037–43.
6.
MartinR.G., MillerJ.D., CoxCC3rd, FerrelS.C., RaananM.G.Safety and efficacy of intracameral injections of unpreserved lidocaine to reduce intraocular sensation.J Cataract Refract Surg1998; 24: 961–3.
7.
CarinoN.S., SlomovicA.R., ChungF., MarcovichA.L.Topical tetracaine versus topical tetracaine plus intracameral lidocaine for cataract surgery.J Cataract Refract Surg1998; 24: 1602–8.
8.
AnnenD.J., HofmannH., HotzR.U.Intra-chamber lidocaine in addition to tetracaine eyedrop anesthesia in clear cornea phacoemulsification.Klin Monatsbl Augenheilkd1998; 212: 278–9.
9.
TsengS.H., ChenF.K.A randomized clinical trial of combined topical-intracameral anesthesia in cataract surgery.Ophthalmology1999; 106: 1644–5.
10.
GillowT., ScotcherS.M., DeutschJ., WhileA., QuinlanM.P.Efficacy of supplementary intracameral lidocaine in routine phacoemulsification under topical anesthesia.Ophthalmology2000; 107: 1803–4.
11.
BoultonJ.E., LopatatzidisA., LuckJ., BaerR.M.A randomized controlled trial of intracameral lidocaine during phacoemulsification under topical anesthesia.Ophthalmology2001; 108: 833–4.
12.
PangM.P., FujimotoD.K., WilkensL.R.Pain, photophobia, and retinal and optic nerve function after phacoemulsification with intracameral lidocaine.Ophthalmology2001; 108: 2018–25.
13.
GarciaA., LoureiroF., LimaoA., SampaioA., IlharcoJ.Preservative-free lidocaine 1% anterior chamber irrigation as an adjunct to topical anesthesia.J Cataract Refract Surg1998; 24: 403–6.
14.
MasketS., GokmenF.Efficacy and safety of intracameral lidocaine as a supplement to topical anesthesia.J Cataract Refract Surg1998; 24: 956–60.
15.
ElviraJ.C., HuesoJ.R., Martinez-ToldoJ., MengualE., ArtolaA.Induced endothelial cell loss in phacoemulsification using topical anesthesia plus intracameral lidocaine.J Cataract Refract Surg1999; 25: 640–2.
16.
IradierM.T., FerandezC., BohorquezP., MorenoE., Del CastiloJ.B., GarciaJ.Intraocular lidocaine in phacoemulsification: an endothelium and blood-aqueous barrier permeability study.Ophthalmology2000; 107: 896–900.
LiouS.W., ChiuC.J., WangI.J.Effect of intracameral injection of lidocaine and carbachol in the rabbit corneal endothelium.J Cataract Refract Surg2004; 30: 1351–5.
19.
GerdingP.A.Jr., TurnerT.L., HamorR.E., SchaefferD.J.Effects of intracameral injection of preservative-free lidocaine on the anterior segment of the eyes in dogs.Am J Vet Res2004; 65: 1325–30.
KadonosoK., ItoN., YazamaF.Effect of intracameral anesthesia on the corneal endothelium.J Cataract Refract Surg1998; 24: 1377–81.
22.
KarpC.L., CoxT.A., WagonerM.D., AriyasuR.G., JacobsD.S.Intracameral anesthesia: a report by the American Academy of Ophthalmology.Ophthalmology2001; 108: 1704–10.
23.
GuzeyM., SaticiA., DoganZ., KaradedeS.The effects of bupivacaine and lidocaine on the corneal endothelium when applied into the anterior chamber at the concentrations supplied commercially.Ophthalmologica2002; 216: 113–7.
24.
AttilaH., TekeliO., CanB., KarelF., SaranY.Effects of intracameral lidocaine on ocular tissues.Clin Exp Ophthalmol2003; 31: 73–7.
25.
AndersonN.J., WoodsW.D., KimT., RudnickD.E., EdelhauserH.F.Intracameral anesthesia: in vitro iris and corneal uptake and wash out of 1% lidocaine hydrochloride.Arch Ophthalmol1999; 117: 225–32.
26.
TrivediR.H., WernerL., AppleD.J., IzakA.M., PandeyS.K., MackyT.A.Viscoanesthesia part I: toxicity to corneal endothelial cells in a rabbit model.J Cataract Refract Surg2003; 29: 550–5.
27.
MackyT.A., WernerL., AppleD.J., IzakA.M., PandeyS.K., TrivediR.H.Viscoanesthesia part II: toxicity to intraocular structures after phacoemulsification in a rabbit model.J Cataract Refract Surg2003; 29: 556–62.
28.
PandeyS.K., WernerL., AppleD.J., IzakA.M., TrivediR.H., MackyT.A.Viscoanesthesia part III: removal time of OVD/vis-coanesthetic solutions from the capsular bag of postmortem human eyes.J Cataract Refract Surg2003; 29: 563–7.
29.
WernerL., PandeyS.K., IzakA.M., HickmanM.S., LeBoyerR.M., MamalisN.Evaluation of the cataractogenic effect of viscoanesthetic solutions on the rabbit crystalline lens.J Cataract Refract Surg2005; 31: 1414–20.
30.
Poyales-GalanF., PirazzoliG.Clinical evaluation of endothelial cell decrease with VisThesia in phacoemulsification surgery.J Cataract Refract Surg2005; 31: 2157–61.
31.
ChangY.S., TsengS.Y., TsengS.H., WuC.L.Cytotoxicity of lidocaine or bupivacaine on corneal endothelial cells in a rabbit model.Cornea2006; 25: 590–6.
32.
ArshinoffS.A., WongE.Understanding, retaining, and removing dispersive and pseudodispersive ophthalmic viscosurgical devices.J Cataract Refract Surg2003; 29: 2318–23.
33.
RavalicoG., TognettoD., BaccaraF., LovisatoA.Corneal endothelial protection by different viscoelastics during phacoemulsification.J Cataract Refract Surg1997; 23: 433–9.
MiyataK., YamagamiS., NejimaR., MiyazakiK., AmanoS.Corneal endothelial cell protection with Viscoat and Healon or Healon alone during penetrating keratoplasty.Cornea2005; 24: 962–6.
