A Substantive Narrative Review on the Usage of Lidocaine in Cataract Surgery

Cardiovascular effects of diluted intracameral combination of 0.02% tropicamide, 0.31% phenylephrine, and 1% lidocaine during phacoemulsification to manage intraoperative miosis

PURPOSE

Intracameral mydriatic agents (ICMAs) are replacing the conventional method of topical mydriasis for its fast action and no need for repeated instillation before cataract surgery. Its application for the management of intraoperative miosis needs to be studied with different doses of mydriatic agent. The objective of the study is to study cardiovascular effects of diluted intracameral combination of 0.02% tropicamide, 0.31% phenylephrine, and 1% lidocaine during phacoemulsification to manage intraoperative miosis.

MATERIALS AND METHODS

The study was conducted at Mojiram Lions Eye Hospital Akbarpur Majra village, Palla Bakhtawarpur Road, Delhi, during the year 2021-2022 after taking approval from the Ethical Committee of the hospital. Patients undergoing cataract surgery who were not dilated adequately during the preoperative period or developed intraoperative miosis were managed by injecting diluted intracameral combination of 0.02% tropicamide, 0.31% phenylephrine, and 1% lidocaine (phenocaine plus). 0.5 ml of phenocaine plus was diluted with 1.5 ml of ringer lactate solution and 0.50 ml of this solution was injected intracameral and its effect on pulse rate, blood pressure (BP), and oxygen saturation were monitored continuously on pulse oximeter.

RESULTS

There was no statistically significant effect of diluted ICMA (Phenocaine Plus) on diastolic BP and oxygen saturation. However, systolic BP showed a little change from mean of 133.78 (standard deviation [SD] =16.04) mmHg to 133.92 (SD = 15.33) mmHg which was statistically significant but clinically not significant. Pulse rate increased slightly from mean 76.46 per minutes (SD = 15.14) to 79.40 (SD = 14.95) at 10 s and 76.49 (SD = 15.15) at 60 s. The difference was again statistically significant but clinically insignificant.

CONCLUSION

Low concentration of intracameral combination of 0.02% tropicamide, 0.31% phenylephrine, and 1% lidocaine is a very safe and effective method for the management of intraoperative miosis.

Deep Learning and Medical Image Processing Techniques for Diabetic Retinopathy: A Survey of Applications, Challenges, and Future Trends

Diabetic retinopathy (DR) is a common eye retinal disease that is widely spread all over the world. It leads to the complete loss of vision based on the level of severity. It damages both retinal blood vessels and the eye's microscopic interior layers. To avoid such issues, early detection of DR is essential in association with routine screening methods to discover mild causes in manual initiation. But these diagnostic procedures are extremely difficult and expensive. The unique contributions of the study include the following: first, providing detailed background of the DR disease and the traditional detection techniques. Second, the various imaging techniques and deep learning applications in DR are presented. Third, the different use cases and real-life scenarios are explored relevant to DR detection wherein deep learning techniques have been implemented. The study finally highlights the potential research opportunities for researchers to explore and deliver effective performance results in diabetic retinopathy detection.

Comparing Efficacy and Safety of Intracameral Injection of Marcaine and Lidocaine on Postoperative Pain and Recovery After Cataract Surgery

Background: Various topical (intracameral) analgesics are used to relieve postoperative pain after cataract surgery. Objectives: We decided to compare the effects of intracameral Marcaine and lidocaine on pain intensity after the cataract operation. Methods: In this double-blind, randomized clinical trial, 64 patients who were candidates for cataract surgery were randomly assigned to either anesthesia with lidocaine or bupivacaine (Marcaine) by intracameral injection. Study endpoints included pain score, hemodynamic status, patient satisfaction, and recovery duration. Results: The Marcaine group experienced a shorter recovery than another group (P = 0.001). The mean pain score at the different time points after the operation was significantly lower in the group receiving Marcaine than those receiving lidocaine (P < 0.001). Our study showed a higher level of patients’ satisfaction with Marcaine as compared to the lidocaine group (P = 0.026). However, postoperative hemodynamic status was similar in both groups. Conclusions: Compared with lidocaine, intracameral injection of Marcaine results in a shorter postoperative recovery period, reduced pain intensity, and higher satisfaction among patients after cataract surgery.