K 753Cataract surgery using lidocaine gel anesthesia and peribulbar anesthesia in eyes with low endothelial cell counts
Z. Sherif, S. Lechner, N. Anders
Background: Low endothelial cell counts are supposed to be a risk factor for transient corneal decompensation following cataract surgery. To avoid mechanical irritation and to minimize ocular motility it is often recommended to perform peribulbar anesthesia rather than lidocaine gel anesthesia. Additionally, i.o. applied lidocaine in lidocaine gel anesthesia may have a toxic effect on corneal endothelium. In this retrospective clinical investigation we examined the rate of transient corneal decompensation following cataract surgery in both forms of anesthesia.
Methods: For 1998 and 1999 we documented all patients with an endothelial cell count £ 1500 mm² who underwent phacoemulsification and IOL implantation in peribulbar or lidocaine gel anesthesia. In slit lamp microscopy all eyes showed a normal corneal appearance, especially no C. guttata. For cell count we used a non-contact specular microscope ROBO-CA (KONAN). For peribulbar anesthesia 4-6ml prilocaine 2% in addition with 150 IU hyaluronidase/10ml were injected. One drop of Xylocaine 2% gel was applied on the conjunctiva and 0,15ml lidocaine 1% was given i.o. for gel anesthesia. All patients were operated on by the same surgeon and were examined using a slit lamp on the first postoperative day.
Results: 78 patients were included. The cell count was 1148/mm² (mean) (SD=104). 48 patients were operated on using lidocaine gel anesthesia and 30 patients were operated on performing peribulbar injection. In the first group 5 patients postoperatively showed folds of the descemet membrane, so did 3 of the patients undergoing peribulbar anesthesia. No patient developed a transient corneal decompensation.
Discussion: Although there was no abnormality in slit lamp examination specular microscopy revealed low endothelial cell counts. In this clinical investigation there was no significant difference in the rate of transient corneal decompensation following cataract surgery between the two groups performing peribulbar injection or lidocaine gel anesthesia.
Department of Ophthalmology Charité, Campus Virchow-Klinikum, D-13353 Berlin