Despite wider spread use of 2% lidocaine gel as an anesthetic agent for ocular procedures, a group at the Department of Ophthalmology and Scientific Computing Center, SUNY Downstate Medical Center, Brooklyn, N.Y, reports that it has not yet been evaluated for use in pain reduction in outpatient eyelid surgery. The aim of their study was to investigate whether transconjunctival local anesthetic with 2% lidocaine gel can be used to reduce pain for minor eyelid procedures compared with transcutaneous administration.
The randomized controlled clinical trial enlisted 120 patients undergoing bilateral upper or lower eyelid surgery. Topical 2% lidocaine gel was administered to the palpebral conjunctiva for one minute, followed by a local transconjunctival injection. Local anesthetic was administered to the contralateral eyelid by a transcutaneous approach without use of topical anesthetic. Both injections were 1 ml of 1% lidocaine with epinephrine 1:100,000 in a 30-ga. needle. After each injection, patients rated the pain on a 0-to-10 visual analog scale. Patients were also asked for preference between the two sides.
The mean pain scores were 2.33 (standard deviation 0.98) for the transconjunctival side and 3.42 (standard deviation 0.88) for the transcutaneous side. The reduction in pain scores for lidocaine gel-treated sides was statistically significant (p<0.001) when controlling for side of intervention, upper versus lower eyelid procedures, sex of participants and type of procedure. In addition, 85 percent of participants found the transconjunctival injection to be less painful than the transcutaneous (p<0.001)
The group concludes that transconjunctival local anesthesia in conjunction with topical anesthesia with 2% lidocaine gel provides a clinically and statistically significant decrease in perceived pain when compared with transcutaneous anesthesia in patients undergoing outpatient eyelid surgery.
Ophthal Plast Reconstr Surg 2015;31:470-3.
Rafailov L, Kulak A, Weedon J, Shinder R.
Separating Depression from Dry-Eye Disease
Research at the University of Illinois at Chicago sought to determine whether the presence of depression in dry-eye disease may cause patients to perceive symptoms in an anomalous fashion compared with patients without depression. The authors cite a similarity to the relationship between psychological and psychophysiological characteristics with fibromyalgia. They theorized that if depression were treated independently and its contribution to patients’ dry-eye symptoms were removed from the equation, then it may be possible to manage dry-eye disease with less aggressive treatments (i.e., frequency of medication intake and the type of medication).
In a case-control study, they used the Beck Depression Inventory (BDI) to measure depressive symptoms in patients with DED and controls to determine the association between depressive and DED symptoms.
Fifty-three patients with DED and 41 controls were recruited. DED symptoms were assessed using the Symptom Burden Tool and Ocular Surface Disease Index tool. Depressive symptoms were assessed using the BDI. Regression diagnostics were performed to detect outliers. Linear statistical models and polynomial regression were used to determine the relationship between depressive symptoms and DED symptoms. An independent t test was performed to determine differences in BDI scores between cases and controls. Scatter plots were generated and linear regression was used to estimate the association between scores. Logistic regression was used for the DED dichotomous outcome and depression status as exposure.
Regression models revealed that the association is linear more than quadratic or cubic. After adjusting for age, sex, race and psychiatric medication, the regression coefficient between DED symptoms and depressive symptoms among DED cases was 1.22 (95% confidence interval, 0.27 to 2.18). DED symptom scores and depression scores were statistically significantly different between DED cases and controls. Adjusted logistic regression revealed an odds ratio of 2.79 (95% confidence interval, 0.96 to 8.12).
The group concludes that the study provides further evidence regarding the association between DED and depression and their symptoms. Prospective studies are needed to understand the mechanisms underlying the association between symptoms of depression and symptoms of DED.
Hallak J, Tibrewal S, Jain S.
Choosing the Best IOL Power When Data May Not be Available
A prospective interventional case series at the G.B. Bietti Foundation-IRCCS, Rome, Italy, compared the results of methods to calculate intraocular lens power after myopic excimer laser surgery.
Eyes were classified into four groups: Group 1 (preop keratometry available, refractive change known); Group 2 (preop keratometry available, refractive change uncertain); Group 3 (preop keratometry unavailable, refractive change known); and Group 4 (preop keratometry unavailable, refractive change unknown). The IOL power was calculated by 19 methods. The median absolute error in refraction prediction and the percentage of eyes with a refraction prediction error within ±0.5 diopter were calculated.
In Group 1 (n=30), the Savini, Seitz/Speicher/Savini, and Masket methods provided the lowest median absolute error (0.29 D, 0.35 D, and 0.34 D, respectively), with more than 70 percent of eyes within ±0.5 D of the predicted refraction. In Group 2 (n=16), the Seitz/Speicher method achieved the best result (median absolute error 0.37 D), with 75 percent of eyes within ±0.5 D of the predicted refraction. In Group 3 (n=18), the Masket method provided the lowest median absolute error (0.24 D), with 72.2 percent of eyes within ±0.5 D of the predicted refraction. In Group 4 (n=6), the Shammas no-history method had the lowest median absolute error (0.31 D), with 83 percent of eyes within ±0.5 D of the predicted refraction.
The researchers conclude that IOL power can be accurately calculated in post-laser surgery eyes when the preop corneal power and refractive change are known and when they are not.
J Cataract Refract Surg 2015;41:1880-8.
Savini G, Barboni P, Carbonelli M, Ducoli P, Hoffer KJ.