Deep topical anesthesia with ropivacaine-soaked sponge for phacoemulsification

Cellular toxicity profile of a new ophthalmic sponge

Introduction: Ophthalmic sponges are used for cleaning the eye surface and absorbing fluids during ophthalmic procedures. This study compared the biological safety and stability of a new ophthalmic sponge, Occucell® (OccuTech Inc, Seongnam, Korea), on the human conjunctival epithelial cells with those of preexisting products to evaluate its clinical application.Materials and Methods: The cytotoxicity of four products, Occucell, a new product, Ultracell®, Eyetec-1, and Eyetec-2, on conjunctival epithelial cells, was evaluated using the MTT (3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide) analysis. Additionally, human conjunctival epithelial cells were stained with a Live & Dead marker and observed using a fluorescence microscope. To evaluate the effect of the ophthalmic sponges on the secretion of IL-1β and TNF-α, cultured conjunctival epithelial cells were treated with 0.5% DMSO eluates of the ophthalmic sponges, and IL-1β and TNF-α mRNA levels were estimated using real-time polymerase chain reaction assays.Results: Cells treated with Occucell showed comparable viability to those treated with other preexisting products. Conjunctival epithelial cells showed more than 90% viability when treated with the ophthalmic sponge extracts, as determined by the MTT assay. No significant differences in the number of live & dead cells were observed between the control and treatment groups. Cells treated with all four ophthalmic sponge eluates showed similar IL-1β and TNF-α mRNA levels.Discussion: Occucell, an eye sponge used during ophthalmic surgery in clinical practice, did not affect the viability of conjunctival epithelial cells, and more than 90% of the cells were viable after the treatment. Further, Occucell showed similar effects on IL-1β and TNF-α secretion as that of other ophthalmic sponges used in the clinic. This suggested that Occucell is a safe product comparable to the preexisting products.

A double-blinded randomized clinical trial for pain perception: The efficacy and safety of topical cold saline solution anesthesia in phacoemulsification

Purpose:

To compare the efficacy and safety of cold saline solution (0.9% NaCl) with topical ophthalmic proparacaine for maintaining topical anesthesia of patients undergoing phacoemulsification surgery.

Methods:

The prospective, double-blinded, and randomized clinical study was randomly assigned to two groups that underwent phacoemulsification surgery due to cataracts. The cold saline group included 86 eyes of 86 patients with topical anesthesia of cold saline solution alone. The proparacaine group included 84 eyes of 84 patients with topical ophthalmic proparacaine (room temperature) anesthesia alone. The patients were scored according to a pain survey questionnaire of Visual Analog Scale (VAS) ranked between 0 and 10. The surgeon scored surgical experience by a Surgeon Questionnaire Scale (SQS) in three parameters, each of which was ranked from 1 to 3 based on questions regarding ease and comfort during the surgery.

Results:

The mean VAS scores were 1.29 ± 0.65 and 1.22 ± 0.66 for the cold saline and proparacaine groups, respectively (P = 0.182). The mean scores of SQS (lower values represented favorable results) were 4.11 ± 0.76 and 3.97 ± 0.74 in the cold saline and proparacaine groups, respectively (P = 0.163). Ten patients in the proparacaine group experienced corneal epitheliopathy in the postoperative period.

Conclusion:

As an easily accessible and cost-effective method, cold saline solution alone might be an alternative to topical ophthalmic proparacaine alone with comparable safe and effective results. The absence of allergic or toxic effects also provided a significant advantage in the cold saline application.

Non-Toxic Anesthesia for Cataract Surgery

Background: To study the safety and efficacy provided by a minimal and localized anesthesia in cataract surgery. Methods: Randomized controlled trial. A total of 100 patients undergoing cataract surgery were randomly divided into two groups of 50, which respecitvely received conventional topical anesthesia consisting of preservative-free Oxibuprocaine hydrochloride 0.4% drops or minimal localized anesthesia, administered with a cotton bud soaked in preservative-free Oxibuprocaine hydrochloride 0.4% applied to clear cornea on the access sites for 10 s immediately before surgery. The mean outcome measures were intraoperative pain and the incidence of postoperative ocular discomfort. Results: All patients tolerated well the procedure, giving patin scores between 1–3. Fifteen patients (30%) of group 1 and ten of group 2 (25%) required supplemental anesthesia. No intraoperative complications were recorded. No eyes had epithelial defects at the end of the surgery or at postoperative check-ups. Conclusions: Minimal anesthesia in cataract surgery resulted quick, safe and non-invasive.