白内障术中前房内注射利多卡因和肾上腺素合剂的安全性和有效性研究

Safety and effectiveness of pupil dilation with intracameral injection of lidocaine and epinephrine combination in cataract surgery

目的探讨白内障手术中在前房内注射利多卡因和肾上腺素合剂以快速散瞳的安全性和有效性。方法前瞻性病例对照研究。选取2020年1~12月于我院诊断为年龄相关性白内障(ARC)并拟行手术治疗的患者61例(61只眼),以随机数字表法分为两组,前房注射散瞳(ICM)组在白内障术中完成首次角膜切口后即刻向前房注射200μl利多卡因和肾上腺素合剂,局部滴眼液散瞳(TM)组从术前30 min开始接受复方托吡卡胺滴眼液散瞳,两组均接受相同方案的盐酸奥布卡因滴眼液滴眼进行表面麻醉,对所有手术进行录像,比较两组患者手术时间、散瞳效果、麻醉效果及术前、术后1周和术后1个月裸眼视力及角膜内皮情况。结果手术前后不同时间点两组术眼间最佳矫正视力(BCVA)、角膜内皮细胞密度(ECD)及六角形细胞比例(HEX)比较差异均无统计学意义(F_(分组)=3.434,P=0.069;F_(分组)=0.333,P=0.566;F_(分组)=1.629,P=0.207);两组术眼术后各时间点BCVA、ECD及HEX均小于各组术前值(均P<0.05)。ICM组在撕囊前(T1)、人工晶状体植入前(T2)和手术结束时(T3)瞳孔直径分别为(7.50±0.60)mm、(6.74±0.64)mm和(6.49±0.66)mm,TM组在T1、T2和T3瞳孔直径分别为(7.66±0.59)mm、(6.49±0.66)mm和(6.49±0.66)mm,两组在T1瞳孔散大程度差异无统计学意义(P>0.05),但在T2和T3时间点,ICM组瞳孔较TM组小且有差异均有统计学意义(t=4.398、5.543,均P<0.05);ICM组患者术中舒适度较TM组高(t=2.167,P<0.05);ICM组和TM手术时间分别为(13.06±1.69)min和(13.06±1.69)min,差异无统计学意义(P>0.05)。结论白内障术中在前房内注射利多卡因和肾上腺素合剂较传统局部滴眼散瞳的有效性和安全性相当,可以成为未充分散瞳患者的补救方案。

Objective To investigate the safety and efficacy of intracameral injection of a combination of lidocaine and epinephrine for rapid pupil dilation during cataract surgery.Methods A prospective 1-year control study was conducted.A total of 61 patients with 61 eyes who were diagnosed with age-related cataract(ARC)in our hospital from January 2020 to December 2020 and planned to undergo surgical treatment were selected and divided into two groups by random number table method.The anterior chamber injection pupil dilatation(ICM)group was injected with 200μL lidocaine and epinephrine mixture into the anterior chamber immediately after completing the first corneal incision during cataract surgery,and local eye drops mydriasis(TM)group received compound tropicamide eye drops 30 minutes before the surgery,both groups received the same regimen of oxybucaine hydrochloride eye drops for topical anesthesia,all operations were recorded,and the operation time,pupil dilation effect,anesthesia effect,preoperative and postoperative 1 week and 1 month postoperative uncorrected visual acuity and corneal endothelium were compared between the two groups.Results The differences in BCVA,ECD and HEX between the two groups at different time points before and after the surgery were not statistically significant(F_(group)=3.434,P_(group)=0.069;F_(group)=0.333,P_(group)=0.566;F_(group)=1.629,P_(group)=0.207).The BCVA,ECD and HEX of the two groups were lower than the preoperative values at each time point after the operation(all P<0.05).In ICM group,the pupil diameters before capsulorhexis(T1),before intraocular lens implantation(T2)and at the end of surgery(T3)were(7.50±0.60)mm,(6.74±0.64)mm and(6.49±0.66)mm,respectively.The pupil diameters of the TM group at T1,T2 and T3 were(7.66±0.59)mm,(6.49±0.66)mm and(6.49±0.66)mm,respectively.There was no statistical difference in the degree of pupil dilation at T1 between the two groups(P>0.05),but at the time points of T2 and T3,the pupils of the ICM group were smaller than those of the TM group and there was a statistical difference(t=4.398,5.543,all P<0.05).The intraoperative comfort of the ICM group was higher than that of the TM group(t=2.167,P<0.05).The operation time of ICM group and TM were(13.06±1.69)and(13.06±1.69)minutes,respectively,and the difference was not statistically significant(P>0.05).Conclusions Intracameral injection of lidocaine and epinephrine combination during cataract surgery is comparable in efficacy and safety to traditional topical eye drops for pupil dilation and may be a remedial option for patients with inadequate pupil dilation.