Topical-intracameral anesthesia combo requires further study

This study was a meta-analysis of eight randomized controlled trials comparing the use of topical anesthesia alone with a combination of topical and intracameral anesthesia during phacoemulsifation. The study's authors found that the data indicated a small reduction in intraoperative pain when supplemental intracameral lidocaine was used compared with topical anesthesia only. However, due to the heterogeneity of the outcomes measured in the included studies, the authors could not rule out the possibility of the occurrence of adverse side effects due to the addition of intracameral lidocaine.

Despite these conclusions, the clinical experience of many surgeons has been that, when necessary, the addition of nonpreserved lidocaine to topical anesthesia is very safe and quite effective. I think that this topic needs to be explored in a more objective, methodical manner, as the authors recommend.