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The effect of intracameral anesthesia on macular thickness and ganglion cell-inner plexiform layer thickness after uneventful phacoemulsification surgery
ISRCTN ISRCTN94155463
DOI 10.1186/ISRCTN94155463
ClinicalTrials.gov identifier
EudraCT number
Public title The effect of intracameral anesthesia on macular thickness and ganglion cell-inner plexiform layer thickness after uneventful phacoemulsification surgery
Scientific title The effect of intracameral anesthesia on macular thickness and ganglion cell-inner plexiform layer thickness after uneventful phacoemulsification surgery: Prospective and randomized controlled trial.
Acronym N/A
Serial number at source Balikesir University, 2013-16
Study hypothesis To evaluate the effect of intracameral lidocaine anesthesia on macular thickness and macular ganglion cell-inner plexiform layer (GC-IPL) thickness following uneventful phacoemusification in healthy subjects.
Lay summary Background and study aims
Pseudophakic cystoid macular edema (CME) remains as one of the most common causes of unfavourable visual outcomes after uneventful cataract surgery. Its incidence has been reported as 0.1 to 5% in healthy population. The exact reason is not fully understood. An ideal anaesthetic (numbing) agent for cataract surgery should facilitate this stressful procedure for both the surgeons and the patient. The use of topical anaesthetic agents has gained widespread acceptance, with a preference rate of about 61% among all eye surgeons. Many surgeons who perform cataract surgery under topical anaesthesia also prefer the use of supplementary intracameral lidocaine (used for pupil dilation) during the surgery. Although a conclusion about its safety has not been reached yet, the toxic effects of lidocaine on retinal ganglion cells have been confirmed by previous animal and human studies. In this study we find out the effects of intracameral anaesthesia on specific properties of the macular cells of the eye, after an uneventful cataract surgery in otherwise healthy subjects.

Who can participate?
Patients, aged between 45 and 85 years, requiring cataract surgery for the treatment of senile cataract were enrolled.

What does the study involve?
All patients were randomly assigned to one of two groups : the intracameral lidocaine group received an intracameral injection (into the eye) of lidocaine at the beginning of the procedure, while the sham injection group received an intracameral injection of a dummy. In both groups, two surgeons performed a standard cataract surgery.

What are the possible benefits and risks of participating?
Patients are treated with cataract surgery for the regaining their vision. Some complications can occur such as infection, tear and poor vision after surgery. However, the tests done in this study do not have any potential risks such as radiation exposure.

Where is the study run from?
The study ran from the ophthalmology department of Balikesir University, Turkey.

When is study starting and how long is it expected to run for?
The study ran between March 2013 and June 2013.

Who is funding the study?
The study was funded by the ophthalmology department, Balikesir University, Turkey.

Who is the main contact?
Dr Esin Sogutlu Sarý
+90 505 641 0199
dresinsogutlu@gmail.com
Ethics approval Balikesir University Ethical Committee approved before inclusion of the first cataract patients
Study design Randomized and double masked study
Countries of recruitment Turkey
Disease/condition/study domain Senile cataract
Participants - inclusion criteria Patients requiring phacoemulsification surgery for the treatment of senile cataract were included. Inclusion criteria were the presence of senile cataract between 45 and 85 years of age and a clear fundus examination before the surgery.
Participants - exclusion criteria Exclusion criteria were
1. Pre-existing macular diseases such as macular edema, epiretinal membrane, macular hole and age-related macular degeneration
2. Ocular diseases such as diabetic retinopathy, glaucoma and previous uveitis
3. Pre-existing refractive error: ±3.00 dioptries
4. History of previous intraocular surgery (except cataract surgery in the fellow eye within the previous 6 months) or laser treatment
5. Diabetes, hypertension or other systemic disease that could affect the eye and topical and/or systemic medications with known interference on macular thickness such as steroids and diuretics.
6. Patients with operative complications and eyes with media opacities which could reduce the signal strength and lead to a segmentation error in preoperative measurements were also excluded from the study.
Anticipated start date 01/03/2013
Anticipated end date 01/06/2013
Status of trial Completed
Patient information material Not available in web format, please use the contact details below to request a patient information sheet
Target number of participants 100
Interventions Optical coherence tomography imaging was performed before and after the cataract surgery
All patients were randomly assigned a number based on a surgical chart:
1. intracameral lidocaine group received an intracameral injection of preservative-free lidocaine 1% (0.5 cc) at the beginning of the procedure
2. sham injection group received intracameral injection of balanced salt solution (BSS) (0.5 cc)
All patients underwent standard phacoemulsification surgery. Optical coherence tomography imaging was performed before surgery and at 1 day, 2 day, 1 week, 1 month and 3 months after surgery.
Primary outcome measure(s) Macular thickness analyses with spectral domain optical coherence tomography measured at baseline and at 1 day, 2 days, 1 week, 1 month and 3 months after surgery.
Secondary outcome measure(s) Ganglion cell-inner plexiform layer and peripapiller retinal nerve fiber layer thickness analyses as well as visual acuity changes measured at baseline and at 1 day, 2 days, 1 week, 1 month and 3 months after surgery.
Sources of funding Ophthalmology Department, Balikesir University, Turkey
Trial website
Publications 2014 results in: http://www.ncbi.nlm.nih.gov/pubmed/24390400
Contact name Dr  Esin  Sogutlu Sarý
  Address Paþaalaný mah. 253. sok Deniz 2 apt daire:4
Balýkesir
  City/town Balýkesir
  Zip/Postcode 10123
  Country Turkey
  Tel +90 505 641 0199
  Email dresinsogutlu@gmail.com
Sponsor Balikesir University (Turkey)
  Address Ophthalmology Department
Bigadic Road,
17th km, Cagis Campus
  City/town Balikesir
  Zip/Postcode n/a
  Country Turkey
  Email dresinsogutlu@gmail.com
Date applied 01/09/2013
Last edited 26/08/2014
Date ISRCTN assigned 20/09/2013
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