Effect of lidocaine on lens epithelial cells
We commend Vargas and coauthors for their excellent work evaluating the effect of lidocaine on lens epithelial cells (LECs). By using lidocaine 1% for hydrodissection, they found that LECs were virtually eliminated from the anterior capsule.
We certainly concur that lidocaine can be used effectively for hydrodissection. We would like to raise a word of caution, however. When using higher dosages of lidocaine (as would be required for hydrodissection), the risk for toxic anterior segment syndrome (TASS) may increase. Three of our patients who received 1.5 cc of preservative-free lidocaine 1% experienced TASS. Although other factors have been implicated as causes of TASS,1–3 we believe lidocaine was the culprit among our patients for the following reasons:
- TASS occurred only in patients who received topical anesthesia supplemented with intraocular lidocaine. One case involved a toric rotation procedure in which lidocaine was the only intraocular fluid introduced.
- In each incident, the patient received a higher dosage than is normally administered during cataract surgery.
We therefore recommend judicious use of lidocaine for hydrodissection and limiting the amount administered to 1.0 cc.
James P Gills MD
Tampa, FL, USA
1. Jehan FS, Mamalis N, Spencer TS, et al. Postoperative sterile endophthalmitis (TASS) associated with the memorylens. J Cataract Refract Surg 2000; 26:1773-1777
2. Mamalis N. Hydrophylic acrylic intraocular lenses. J Cataract Refract Surg 2001; 27:1339-1340
© 2004 by Lippincott Williams & Wilkins, Inc.
3. Monson MC, Mamalis N, Olson RJ. Toxic anterior segment inflammation following cataract surgery. J Cataract Refract Surg 1992; 18:184-189