1. Anesthetic Effect of Topical Agents in Cataract Surgery Ross B. L. MacIntyre, MD Paul S. Koch, MD Dr. Ross MacIntyre has no financial interests to disclose. Dr. Paul Koch is a paid consultant to and member of the medical advisory board of Ocusoft.

2. Background  Small incision cataract surgery has led to widespread use of topical anesthetic agents  Rapid onset/recovery  Painless application  Low risk  Strategies  Adequate anesthesia is important prior to placing a lid speculum and giving intracameral anesthetics  Drops/aqueous  Gels/viscous – advantage of prolonged corneal contact time  +/- adjunct intracameral 9

3. Purpose  To assess the efficacy four anesthetic methods in routine cataract surgery:  Viscous tetracaine 0.5%  Higher viscocity tetracaine 0.5%  Viscous lidocaine 3.5%  Intracameral lidocaine 1%

4. Methods  Private surgical center  IRB approved  Prospective, randomized, double-blinded study  Inclusion criteria:  Routine cataract surgery by clear corneal phacoemulsification performed by single surgeon  Exclusion criteria:  Complicated cataract surgery requiring any intraocular device

5. Methods  160 patients randomized to 4 groups* 1: Viscous tetracaine 0.5% 2: Higher viscocity tetracaine 0.5% 3: Viscous lidocaine 3.5% 4: Intracameral lidocaine 1%  Outcome measures  Preoperative pain score (0-10)  Postoperative pain score (0-10)  Need for supplemental anesthesia *Groups 1-3 received topical anesthesia only, and all received 0.5 cc of a balanced salt solution intracamerally *Group 4 received topical proparacaine drops, then 0.25 cc of 1% unpreserved lidocaine intracamerally

6. Results  160 eyes of 160 patients  No preoperative pain reported  No additional anesthesia required All statistical analysis was performed using student t-test software available with Microsoft Excel, Office 2000

7. Results  Patients with moderate/severe pain (score > 3)  Viscous tetracaine 0.5%: 11  Higher viscocity tetracaine 0.5%: 3  Viscous lidocaine 3.5%: 4  Intracameral lidocaine 1%: 1

8. Results  Pain score for viscous tetracaine 0.5% was significantly higher than  Higher viscocity tetracaine 0.5% (p=0.037)  Viscous lidocaine 3.5% (p=0.042)  Intracameral lidocaine 1% (p<0.001)  No statistical significant difference between higher viscocity tetracaine 0.5% and viscous lidocaine 3.5% (p=0.46)  Both higher viscocity tetracaine 0.5% (p=0.032) and viscous lidocaine 3.5% (p=0.024) had statistically higher pain scores versus intracameral lidocaine 1%

9. Conclusions  Higher viscocity tetracaine 0.5% and viscous lidocaine 3.5% provide similar anesthesia  Both provide superior anesthesia compared to viscous tetracaine 0.5%  Intracameral lidocaine gives superior pain control versus topical agents alone