Comparison of the effect of the intracameral lidocaine anesthesia and subconjunctival lidocaine anesthesia on the development of intraoperative floppy-iris syndrome in cataract surgery

Year 2021, Volume: 4 Issue: 6, 761 - 765, 24.09.2021

Tayfun Şahin , Sucattin Kocamis

https://doi.org/10.32322/jhsm.919403

Abstract

Aim: To evaluate the effect of intracameral lidocaine anesthesia (ILA) and subconjunctival lidocaine anesthesia (SLA) administered during cataract surgery on the development and prevalence of intraoperative floppy iris syndrome (IFIS).
Material and Method: The study involved the medical records of 86 cataract patients having no risk factors other than small pupil size for IFIS whom ILA and/or SLA were applied during phacoemulsification surgery. While 45 patients were administered intracameral lidocaine anesthesia ILA (1%), 41 patients in the other group were administered subconjunctival lidocaine anesthesia (SLA) (2%). Floppy iris syndrome findings such as iris billowing, iris incarceration in the wound site, or progressive myosis, if any, were recorded. The groups were compared in terms of the prevalence of IFIS development.
Results: While IFIS ratio was 33.7% in the ILA group, it was 17.1% in the SLA group (p=0.084). Patients with smaller pupil diameter observed a higher IFIS rate ( when pupil diameter threshold value was 6.5 mm p=0.011 and 6 mm p=0.009).
Conclusion: During cataract surgery, surgeons should care for the development of IFIS in patients with small pupil diameters. However, the effect of intracameral lidocaine use on the development of IFIS has not been determined.

Keywords

Cataract, phacoemulsification, iris diseases, local anesthesia

References

• Yan W, Wang W, van Wijngaarden P, Mueller A, He M. Longitudinal changes in global cataract surgery rate inequality and associations with socioeconomic indices. Clin Exp Ophthalmol 2019; 47: 453‐60.
• Shah R. Anesthesia for cataract surgery: Recent trends. Oman J Ophthalmol 2010; 3: 107‐8.
• Ezra DG, Allan BD. Topical anaesthesia alone versus topical anaesthesia with intracameral lidocaine for phacoemulsification. Cochrane Database Syst Rev 2007; CD005276.
• Tan CS, Fam HB, Heng WJ, Lee HM, Saw SM, Au Eong KG. Analgesic effect of supplemental intracameral lidocaine during phacoemulsification under topical anaesthesia: a randomised controlled trial. Br J Ophthalmol 2011; 95: 837‐41.
• Anderson CJ. Subconjunctival anesthesia in cataract surgery. J Cataract Refract Surg 1995; 21: 103‐5.
• Neff KD, Sandoval HP, Fernández de Castro LE, Nowacki AS, Vroman DT, Solomon KDl. Factors associated with intraoperative floppy iris syndrome. Ophthalmology 2009; 116: 658‐63.
• Chang DF, Campbell JR. Intraoperative floppy iris syndrome associated with tamsulosin. J Cataract Refract Surg 2005; 31: 664‐73.
• Cheung CM, Awan MA, Sandramouli S. Prevalence and clinical findings of tamsulosin-associated intraoperative floppy-iris syndrome. J Cataract Refract Surg 2006; 32: 1336‐9.
• Takmaz T, Can I. Clinical features, complications, and incidence of intraoperative floppy iris syndrome in patients taking tamsulosin. Eur J Ophthalmol 2007; 17: 909‐13.
• Oshika T, Ohashi Y, Inamura M, et al. Incidence of Intraoperative Floppy Iris Syndrome in Patients on Either Systemic or Topical α1-Adrenoceptor Antagonist. Am J Ophthalmol 2007; 143: 150-1.
• Issa SA, Dagres E. Intraoperative floppy-iris syndrome and finasteride intake. J Cataract Refract Surg 2007; 33: 2142-3.
• Goepel M, Hecker U, Krege S, Rübben H, Michel MC. Saw palmetto extracts potently and noncompetitively inhibit human  alpha1-adrenoceptors in vitro. Prostate 1999; 38: 208-15.
• Ünal M, Yücel İ, Tenlik A. Intraoperative floppy-iris syndrome associated with chronic use of chlorpromazine. Eye 2007; 21: 1241-2.
• Pringle E, Packard R. Antipsychotic agent as an etiologic agent of IFIS. J Cataract Refract Surg 2005; 31: 2240-1.
• Chang DF, Braga-Mele R, Mamalis N, et al. ASCRS Cataract Clinical Committee. ASCRS White Paper: Clinical review of intraoperative floppy-iris syndrome. J Cataract Refract Surg 2008; 34: 2153-62.
• Chang DF, Osher RH, Wang L, Koch DD. Prospective multicenter evaluation of cataract surgery in patients taking tamsulosin (Flomax). Ophthalmology 2007; 114: 957-64.
• Manvikar S, Allen D. Cataract surgery management in patients taking tamsulosin. J Cataract Refract Surg 2006; 32: 1611-4.
• Goldman JM, Karp CL. Adjunct devices for managing challenging cases in cataract surgery: capsular staining and ophthalmic viscosurgical devices. Curr Opin Ophthalmol 2007; 18: 52-7.
• Chylack LT, Wolfe JK, Singer DM, et al. The lens opacities classification system III. the longitudinal study of cataract study group. Arch Ophthalmol 1993; 111: 831-6.
• Savino G, Perrotta V, Colucci D, et al. Mydriasis induced by sub-Tenon’s ropivacaine injection in patients undergoing strabismus surgery. J AAPOS 2010; 14: 124-6.
• Lincoff H, Zweifach P, Brodie S, et al. Intraocular injection of lidocaine. Ophthalmology 1985; 92: 1587-91.
• Chen AA, Kelly JP, Bhandari A, Wu MC. Pharmacologic prophylaxis and risk factors for intraoperative floppy-iris syndrome in phacoemulsification performed by resident physicians. J Cataract Refract Surg 2010; 36: 898-905.
• Klysik A, Korzycka D. Sub-Tenon injection of 2% lidocaine prevents intra-operative floppy iris syndrome (IFIS) in male patients taking oral α-adrenergic antagonists. Acta Ophthalmol 2014; 92: 535-40.
• Oberg TJ, Sikder S, Jorgensen AJ, Mifflin MD. Topical-intracameral anesthesia without preoperative mydriatic agents for Descemet-stripping automated endothelial keratoplasty and phacoemulsification cataract surgery with intraocular lens implantation. J Cataract Refract Surg 2012; 38: 384-6.
• Casuccio A, Cillino G, Pavone C, Spitale E, Cillino S. Pharmacologic pupil dilation as a predictive test for the risk for intraoperative floppy-iris syndrome. J Cataract Refract Surg 2011; 37: 1447–54.