DOI: 10.1097/IAE.0b013e31804b4081

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PMID: 17621193

Issn Print: 0275-004X

Publication Date: 2007/07/01


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Surface Anesthesia for Office-Based Retinal Procedures

ASHEESH TEWARI; GAURAV K. SHAH; MANDEEP S. DHALLA; KEVIN J. BLINDER

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Excerpt

With the advent of pharmacologic therapies for retinal disease, there has been a dramatic increase in the amount of intravitreal injections performed by retina specialists. Minimizing the amount of pain that the patient experiences is critical. Patient discomfort at the time of injection can also lead to sudden movements of the eye, which can be associated with intraocular complications. In addition, with recurring intravitreal injections for diseases such as cystoid macular edema and age-related macular degeneration, patients who have a negative experience with an initial injection may be less likely to continue with a potentially beneficial treatment method.
For intravitreal injections, methods of inducing anesthesia currently used include topical administration of tetracaine, pledget of 4% lidocaine solution, and 2% lidocaine jelly and placement of subconjunctival 2% lidocaine solution with a 30-gauge needle. Although all of these methods can provide topical anesthesia, each has its own shortcomings. Topical tetracaine and 4% lidocaine are not always effective in achieving complete anesthesia. Application of lidocaine jelly to the conjunctiva before povidone–iodine irrigation might create a barrier that may allow surface bacteria to persist.1 Subconjunctival placement of lidocaine can be associated with conjunctival hemorrhage and a risk of inadvertent perforation. In addition, it has been suggested that subconjunctival placement may be associated with an increased risk of endophthalmitis. An evaluation of the relative cost of these options reveals the following: tetracaine, $5.74 (15-mL bottle); 4% lidocaine solution, $6.61 (50-mL bottle); 2% lidocaine jelly, $11.49 (10-mL tube); and 2% lidocaine for subconjunctival injection, $4.35 (20-mL bottle).
We describe an alternative method to achieve topical anesthesia necessary for intravitreal injections with viscous 0.5% tetracaine hydrochloride (Tetravisc, Cynacon/Ocusoft, Inc., Richmond, TX; $14.95 [5-mL bottle]), a medication that is currently being used by some anterior segment surgeons during clear-cornea cataract surgeries.
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