Mydriasis plays an important role in most intraocular surgeries, including phacoemulsification, intraocular lens implantation, and vitreoretinal surgery to expose the lens and posterior segments.1 The effect is mainly achieved through topical administration of parasympatholytics such as atropine and tropicamide.1,2 Topically administered phenylephrine is also used sometimes as an adjunct medication to facilitate mydriasis.1,2 However, the mydriatic effects of topically administered mydriatics occasionally wear off during surgery,3,4 and the mydriatic effects of tropicamide are hindered or nonexistent when preoperative inflammation is present.2 Systemic cardiovascular adverse effects have been reported with the topical administration of sympathomimetics in human and dog eyes and of parasympatholytics in human eyes.5–7
Numerous studies8–11 in humans have been performed to investigate intracameral (in the anterior chamber of the eye) injection of mydriatics as a possible alternative for achieving preoperative mydriasis. Intracameral injection of epinephrine has been used as an adjunct to preoperative mydriatics or as the sole dilating agent in humans and other animals.2,9 In humans, intracamerally injected lidocaine is considered effective at yielding adequate mydriasis and analgesia without considerable systemic or ocular adverse effects.3,4,12,13,a Intracameral injection of preservative-free lidocaine is reportedly safe in humans,14 rabbits,15 and pigs.16
In dogs, the suspected analgesic effect of intracamerally injected lidocaine has been addressed, and the safety of intracameral injections of preservative-free 1% or 2% lidocaine hydrochloride solution has been established.17 However, to the authors' knowledge, no study has been conducted to evaluate the mydriatic effect of intracamerally injected lidocaine in dogs. The purpose of the study reported here was to evaluate the mydriatic effect of intracameral injection of preservative-free 1% and 2% lidocaine hydrochloride solutions and determine the onset and duration of mydriasis according to the concentration and volume of lidocaine administered.
Balanced salt solution
End-tidal partial pressure of CO2
Ozkurt Y. Intraoperative lidocaine in phacoemulsification without preoperative eyedrops (abstr). J Cataract Refract Surg 2006;32:178.
SL-202, Shin-Nippon, Tokyo, Japan.
Keeler Vantage, Keeler, Windsor, Berkshire, England.
Tonopen, Mentor Ophthalmics Inc, Norwell, Mass.
Daehan lidocaine HCl 2%, Dai Han Pharm Co Ltd, Seoul, Republic of Korea.
Daehan lidocaine HCl 1%, Dai Han Pharm Co Ltd, Seoul, Republic of Korea.
Baxter Co, Alliston, ON, Canada.
Sedaject, Samwoo Medical, Yesan, Republic of Korea.
1% Provive, Claris Lifesciences, Vasana, India.
Forane, Choongwae Pharm Co, Seoul, Republic of Korea.
Datex-Ohmeda S/5, GE Healthcare, Madison, Wis.
Leica M-651, Leica Microsystems, Heerbrugg, Switzerland.
SPSS, version 12.0, SPSS Inc, Chicago, Ill.
Wilkie DA, Colitz CMH. Surgery of the canine lens. In: Gelatt KN, ed. Veterinary ophthalmology. 4th ed. Ames, Iowa: Blackwell Publishing, 2007;888–931.
Nikeghbali A, Falavarjani KG, Kheirkhah A. Pupil dilation with intracameral lidocaine during phacoemulsification: benefits for the patient and surgeon. Indian J Ophthalmol 2008;56:63–64.
Nikeghbali A, Falavarjani KG, Kheirkhah A, et al. Pupil dilation with intracameral lidocaine during phacoemulsification. J Cataract Refract Surg 2007;33:101–103.
Kaila T, Korte JM, Saari KM. Systemic bioavailability of ocularly applied 1% atropine eyedrops. Acta Ophthalmol Scand 1999;77:193–196.
Pascoe PJ, Ilkiw JE, Stiles J, et al. Arterial hypertension associated with topical ocular use of phenylephrine in dogs. J Am Vet Med Assoc 1994;205:1562–1564.
Malhotra R, Banerjee G, Brampton W, et al. Comparison of the cardiovascular effects of 2.5% phenylephrine and 10% phenylephrine during ophthalmic surgery. Eye 1998;12:973–975.
Lundberg B, Behndig A. Intracameral mydriatics in phacoemulsification cataract surgery. J Cataract Refract Surg 2003;29:2366–2371.
Liou SW, Chen CC. Maintenance of mydriasis with one bolus of epinephrine injection during phacoemulsification. J Ocul Pharmacol Ther 2001;17:249–253.
Cionni RJ, Barros MG, Kaufman AH, et al. Cataract surgery without preoperative eyedrops. J Cataract Refract Surg 2003;29:2281–2283.
Behndig A, Eriksson A. Evaluation of surgical performance with intracameral mydriatics in phacoemulsification surgery. Acta Ophthalmol Scand 2004;82:144–147.
Tseng SH, Chen FK. A randomized clinical trial of combined topical-intracameral anesthesia in cataract surgery. Ophthalmology 1998;105:2007–2011.
Martin RG, Miller JD, Cox CC III, et al. Safety and efficacy of intracameral injections of unpreserved lidocaine to reduce intraocular sensation. J Cataract Refract Surg 1998;24:961–963.
Iradier MT, Fernandez C, Bohorquez P, et al. Intraocular lidocaine in phacoemulsification: an endothelium and blood-aqueous barrier permeability study. Ophthalmology 2000;107:896–900.
Liou SW, Chiu CJ, Wang IJ. Effect of intracameral injection of lidocaine and carbachol on the rabbit corneal endothelium. J Cataract Refract Surg 2004;30:1351–1355.
Eggeling P, Pleyer U, Hartmann C, et al. Corneal endothelial toxicity of different lidocaine concentrations. J Cataract Refract Surg 2000;26:1403–1408.
Gerding PA Jr, Turner TL, Hamor RE, et al. Effects of intracameral injection of preservative-free lidocaine on the anterior segment of the eyes in dogs. Am J Vet Res 2004;65:1325–1330.
Plumb DC. Ophthalmic products, topical. In: Plumb DC, ed. Plumb's veterinary drug handbook. 5th ed. Ames, Iowa: Blackwell Publishing, 2005;1169–1203.
Hollingsworth SR, Canton DD, Buyukmihci NC, et al. Effect of topically administered atropine on tear production in dogs. J Am Vet Med Assoc 1992;200:1481–1484.
Fraunfelder FT, Meyer SM. Possible cardiovascular effects secondary to topical ophthalmic 2.5% phenylephrine. Am J Ophthalmol 1985;99:362–363.
Lou L, Sabar R, Kaye AD. Drugs used in regional anesthesia (A). In: Raj PP, ed. Textbook of regional anesthesia. New York: Elsevier Science, 2002;177–213.
Wirbelauer C, Iven H, Bastian C, et al. Systemic levels of lidocaine after intracameral injection during cataract surgery. J Cataract Refract Surg 1999;25:648–651.
Karp CL, Cox TA, Wagoner MD, et al. Intracameral anesthesia: a report by the American Academy of Ophthalmology. Ophthalmology 2001;108:1704–1710.
Gills JP, Cherchio M, Raanan MG. Unpreserved lidocaine to control discomfort during cataract surgery using topical anesthesia. J Cataract Refract Surg 1997;23:545–550.
Heuermann T, Hartmann C, Anders N. Long-term endothelial cell loss after phacoemulsification: peribulbar anesthesia versus intracameral lidocaine 1%: prospective randomized clinical trial. J Cataract Refract Surg 2002;28:639–643.
Anderson NJ, Nath R, Anderson CJ, et al. Comparison of preservative-free bupivacaine vs. lidocaine for intracameral anesthesia: a randomized clinical trial and in vitro analysis. Am J Ophthalmol 1999;127:393–402.
Hoffman RS, Fine IH. Transient no light perception visual acuity after intracameral lidocaine injection. J Cataract Refract Surg 1997;23:957–958.
Anders N, Heuermann T, Ruther K, et al. Clinical and electrophysiologic results after intracameral lidocaine 1% anesthesia: a prospective randomized study. Ophthalmology 1999;106:1863–1868.
Lee JJ, Moster MR, Henderer JD, et al. Pupil dilation with intracameral 1% lidocaine during glaucoma filtering surgery. Am J Ophthalmol 2003;136:201–203.
Crandall AS, Zabriskie NA, Patel BC, et al. A comparison of patient comfort during cataract surgery with topical anesthesia versus topical anesthesia and intracameral lidocaine. Ophthalmology 1999;106:60–66.
Ezra DG, Nambiar A, Allan BD. Supplementary intracameral lidocaine for phacoemulsification under topical anesthesia. A meta-analysis of randomized controlled trials. Ophthalmology 2008;115:455–487.