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Purpose: This study compared the efficacy of cyclopentolate hydrochloride at 10-, 20- and 30-min post-instillation in White 6- to 7-year-olds, with and without prior instillation of proxymetacaine hydrochloride. The primary aim was to determine if accurate autorefraction values can be obtained sooner than the current standard of 30-min post-cycloplegia. The secondary aim was to investigate whether proxymetacaine hydrochloride enhances the efficiency of cyclopentolate., Methods: Participants were 112 White 6- to 7-year-olds from the Child Eye Health Study. The right eye received 0.5% proxymetacaine hydrochloride and 1.0% cyclopentolate hydrochloride, and the left eye received only 1.0% cyclopentolate hydrochloride. Non-cycloplegic and cycloplegic refractive error (at 0, 10, 20 and 30 min) was measured using a binocular, open-field autorefractometer. Data were analysed through paired t-tests, concordance analysis, linear regression, equivalence testing and Bland-Altman analysis, using the 95% limits of agreement., Results: Mean spherical equivalent refraction (SER) (SD) in the right eye at 0-, 10-, 20- and 30-min post-instillation was 0.62 (1.45) D, 1.52 (1.80) D, 1.64 (1.81) D and 1.72 (1.80) D, respectively. Mean left eye SER (SD) were 0.68 (1.24) D, 1.42 (1.66) D, 1.56 (1.66) D and 1.68 (1.72) D, respectively. Bland-Altman analysis showed a high level of agreement, and equivalence testing confirmed that there was no clinically significant difference in SER at 20 and 30 min in both eyes (within ±0.50 D), with mean differences of 0.08 (0.23) D in the right eye and 0.13 (0.30) D in the left eye (p = 0.21). However, SER at 10 and 30 min were equivalent in the right eye only., Conclusions: Accurate autorefraction values can be obtained 20-min post-instillation of 1.0% cyclopentolate in white children aged 6-7 years, potentially reducing clinical testing times. Proxymetacaine pre-instillation allows for reliable measurements as early as 10-min post-instillation of cyclopentolate. Further research is needed to validate these findings in non-White populations and to determine the safe discharge time post-proxymetacaine instillation., (© 2024 The Author(s). Ophthalmic and Physiological Optics published by John Wiley & Sons Ltd on behalf of College of Optometrists.)

Aim: To compare the effectiveness of 0.5% and 0.25% proparacaine eye drops in providing topical anesthesia for routine ocular procedures., Methodology: 137 patients (274 eyes) were included in this study. They were categorized into two groups. Group A patients received 0.5% and Group B received 0.25% proparacaine drops. A single surgeon performed all the procedures. Intraprocedural and postprocedural pain scores, surgeon comfort, supplemental anesthesia, and vital parameters, were noted., Results: The mean age of the participants was 69.42 years (±12.05). An equal number of procedures were performed (n = 30) for applanation tonometry, lacrimal sac syringing, and A-scan biometry. The other procedures performed were removal of the conjunctiva (n = 5) and corneal foreign bodies (n = 16 per group), corneal scraping (n = 8 per group), and corneal suture removal (n = 18 per group).The mean visual analog pain score during the procedure was 6.9663 in Group A and 8.0803 in Group B ( P = 0.66). The mean postprocedural pain score was not significant ( P = 0.21). None of the patients required any additional anesthesia during or after the procedure. The average surgeon's experience was 0.152±0.507 in Group A and 0.111±0.402 in Group B ( P = 0.07).In Group A, 133 of 137 patients (97.08%), and in Group B, 132 out of 137 patients (96.35%) preferred to use the same anesthetic for future procedures. None of the patients experienced a vasovagal attack or any change in vital parameters., Discussion: The present study aimed to establish equivalence between two concentrations of proparacaine hydrochloride in which false positive and false negative errors were expected. This is the inherent challenge in the equivalence and inferiority trials. To mitigate these risks, the present study was carefully designed with specific statistical methods, sample size calculation, and rigorous methodology. Nevertheless, it is crucial to recognize that the risk of false positive errors remains, and the results should be interpreted with this in mind., Conclusion: These findings indicated that 0.25% proparacaine is a viable alternative to the standard 0.5% concentration in routine ophthalmic procedures, with the potential for improved patient comfort., Competing Interests: The author states no conflict of interest., (© 2024 The Authors.)

Abstract: Corneal abrasions are among the most common ophthalmic injuries in the emergency department (ED) and primarily present as severe ocular pain. Topical anesthetics provide temporary analgesia, but overuse is associated with complications including further corneal injury, infection, and vision loss. This case series describes three patients who used a 15-mL bottle of 0.05% proparacaine hydrochloride ophthalmic solution after discharge from the ED and returned within three days with corneal injury and pain. Although the use of topical anesthetics is traditionally discouraged by ophthalmologists, publications in the emergency medicine literature support their use. We review the literature surrounding topical anesthetic use in the ED setting and caution against prescribing patients topical anesthetics for corneal abrasions, particularly without patient counseling and significant restriction of anesthetic supply., Competing Interests: A. Zhou, A. Rabljenovic, and T. L. Steinemann declare no conflict of interest., (Copyright © 2024 Contact Lens Association of Ophthalmologists.)

Purpose: The safety and efficacy of a novel topical ocular anesthetic (AG-920 sterile ophthalmic solution, 8%) was previously evaluated in adults. For both clinical and regulatory purposes, this new agent was evaluated in children. Methods: This was a Phase 3, randomized, active-controlled, single-masked, parallel-group design study in healthy pediatric subjects performed at a private practice retina clinic in the United States. The safety and anesthetic efficacy of AG-920 was compared with proparacaine hydrochloride ophthalmic solution 0.5% in 60 children undergoing ophthalmic examinations. The primary efficacy endpoint was whether the investigator was able to perform the eye examination. Results: In all subjects in each treatment group, the investigator was able to perform the eye examination without additional local anesthetic. There were no adverse events reported in this study. In both the study eye and fellow eye, there were no notable changes after dosing, and both treatment groups were similar. All external eye exams in all subjects in both treatment groups were normal. Conclusions: In this pediatric population aged 7 months to >11 years, AG-920 was therapeutically equivalent to marketed proparacaine with respect to having an ophthalmic examination performed without needing additional local anesthetic. Further, AG-920 was well tolerated, and there were no clinically significant safety findings.

Purpose: This study aimed to determine the onset and duration of action of 3 commercially available topical anesthetic solutions in Brazil, using the Cochet-Bonnet esthesiometer (Luneau ® , Paris, France) and to quantitatively assess patient-reported discomfort during application. Methods: A prospective, randomized, masked, and double-blind study was conducted, involving 40 eyes from 21 patients. Patients were administered each one of the topical anesthetics weekly, and corneal sensitivity was measured using the Cochet-Bonnet esthesiometer's corneal touch threshold (CTT). Patients rated the burning sensation using a visual analogue scale (VAS). Results: Among the 21 patients (42.9% male), with a mean age of 31.95 years (±standard deviation = 10.17, range = 22.0-58.0), corneal sensitivity significantly decreased 30 s after application, returning to baseline after 30 min for all groups ( P  < 0.0001). Significant differences in CTT were observed at 5 min, with proparacaine exhibiting a superior anesthetic effect ( P  = 0.0003), at 10 min, where tetracaine displayed the most substantial anesthetic effect ( P  = 0.0135), and at 20 min, where tetracaine demonstrated the highest anesthetic efficacy ( P  < 0.0001). VAS scores indicated the most intense burning sensation with tetracaine ( P  < 0.0001). Men reported experiencing more discomfort during instillation compared with women ( P  = 0.0168). Conclusions: Proparacaine exhibited the fastest onset of action among the 3 topical anesthetics and provided a more comfortable eye sensation during instillation. However, tetracaine demonstrated the longest duration of action despite causing more discomfort.

Clinical Relevance: Reducing the time between drop instillation and refraction reduces the time paediatric patients and young adults spend in practice, facilitating more eye examinations daily., Background: The current procedure for paediatric cycloplegic refraction is to wait for at least 30-minutes post-instillation of a cycloplegic before measuring spherical equivalent refraction. This study compared cycloplegia at 20- and 30-minutes following 0.5% proxymetacaine and 1.0% cyclopentolate in 12-13-year-olds., Methods: Participants were 99 white 12-13-year-olds. One drop of proxymetacaine hydrochloride (Minims, 0.5% w/v, Bausch & Lomb, UK) followed by one drop of cyclopentolate hydrochloride (Minims, 1.0% w/v, Bausch & Lomb, UK) was instilled into both eyes. Spherical equivalent refraction was measured by autorefraction (Dong Yang Rekto ORK-11 Auto Ref-Keratometer) at 20- and 30-minutes post-instillation. Data were analysed through paired t-testing, correlations, and linear regression analysis., Results: There was no significant difference in level of cycloplegia achieved at 20- (Mean spherical equivalent refraction (standard deviation) 0.438 (1.404) D) and 30-minutes (0.487 (1.420) D) post-eyedrop instillation (t (98) = 1.667, p  = 0.099). The mean spherical equivalent refraction difference between time points was small (0.049 (0.294) D, 95% confidence interval =-0.108 ̶ 0.009D). Agreement indices: Accuracy = 0.999, Precision = 0.973, Concordance = 0.972. Spherical equivalent refraction at 20- and 30-minutes differed by ≤0.50D in 92% of eyes, and by <1.00D in 95%., Conclusions: There was no clinically significant difference in spherical equivalent refraction or level of cycloplegia at 20- and 30-minutes post-eyedrop instillation. The latent time between drop instillation and measurement of refractive error may be reduced to 20 minutes in White 12-13-year-olds and young adults. Further studies must determine if these results persist in younger children and non-White populations.

Proparacaine (PPC) is a previously discovered topical anesthetic for ophthalmic optometry and surgery by blocking the central Nav1.3. In this study, we found that proparacaine hydrochloride (PPC-HCl) exerted an acute robust antiepileptic effect in pilocarpine-induced epilepsy mice. More importantly, chronic treatment with PPC-HCl totally terminated spontaneous recurrent seizure occurrence without significant toxicity. Chronic treatment with PPC-HCl did not cause obvious cytotoxicity, neuropsychiatric adverse effects, hepatotoxicity, cardiotoxicity, and even genotoxicity that evaluated by whole genome-scale transcriptomic analyses. Only when in a high dose (50 mg/kg), the QRS interval measured by electrocardiography was slightly prolonged, which was similar to the impact of levetiracetam. Nevertheless, to overcome this potential issue, we adopt a liposome encapsulation strategy that could alleviate cardiotoxicity and prepared a type of hydrogel containing PPC-HCl for sustained release. Implantation of thermosensitive chitosan-based hydrogel containing liposomal PPC-HCl into the subcutaneous tissue exerted immediate and long-lasting remission from spontaneous recurrent seizure in epileptic mice without affecting QRS interval. Therefore, this new liposomal hydrogel formulation of proparacaine could be developed as a transdermal patch for treating epilepsy, avoiding the severe toxicity after chronic treatment with current antiepileptic drugs in clinic., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Purpose: To evaluate whether the standard dilating drop regimen consisting of phenylephrine, tropicamide, and proparacaine produces clinically significant improvement in pupil size compared to tropicamide and proparacaine during diagnostic eye examination. Methods: Sixty-three adult patients at Washington University School of Medicine Eye Clinic were enrolled in this prospective, randomized trial. Each patient received one of two dilating drop regimens: phenylephrine + tropicamide + proparacaine (PE+T+PP), which is considered the standard therapy, or tropicamide + proparacaine (T+PP). Main outcome measures were the proportion of pupils able to achieve successful clinical examination without need for additional dilating drops and change in predilation to postdilation pupil size. Comparisons were made using McNemar's test, repeated measures analysis of variance, and Fisher's test to determine whether PE is a necessary component of the standard eye examination. Results: There were no statistically significant differences between the PE+T+PP and T+PE treatment groups in predilation to postdilation changes in average resting pupil size (1.58 ± 0.66 and 2.61 ± 0.79; P  = 0.57) or constricted pupil size (2.52 ± 0.93 and 3.56 ± 0.96; P  = 0.15). There was no statistically significant difference between patients who obtained a successful dilated pupil examination between those receiving PE+T+PP and those receiving T+PP as determined by the examining physicians (Fisher's, P  = 0.67). Conclusion: The addition of phenylephrine to tropicamide and proparacaine did not improve pupillary dilation size or ability to conduct a clinical examination. A single dilating agent using tropicamide should be considered in clinical practice.

Purpose: Lidocaine gel was suggested to be highly effective in providing anesthesia for intravitreal injections but adverse effects include a possibility of making sterilization of the conjunctiva difficult. Hence, we wished to determine the effect of using 0.5% proparacaine drops alone over the use of 3.5% lidocaine hydrochloride gel anesthesia during office-based intravitreal injections., Methodology: This was a case-control study in patients who came routinely to the clinic for antivascular endothelial growth factor injections. Eyes were treated with one of two anesthesia modalities. A total of 216 injections in 120 patients were reviewed. One group (N = 107) underwent anesthesia with 0.5% proparacaine drops, and the control group (N = 109) received 3.5% lidocaine gel. The pain perceived after injection was graded using the numerical rating scale, and score was immediately recorded by the "masked" injecting physician., Results: The mean pain score (±SD) for the proparacaine-only group versus gel group was 1.97 (±1.17) versus 1.76 (±0.92), P value = 0.3174. There was no statistical difference between the 2 groups., Conclusion: 3.5% lidocaine gel is not superior to 0.5% proparacaine drops as patients attained good pain control and excellent rates of overall satisfaction with proparacaine drops alone.

Purpose: We sought to evaluate whether additional topical anesthetic, specifically proparacaine 0.5%, improved patient experience with intravitreal injections without hindering antisepsis., Methods: A prospective, randomized controlled trial was conducted including 36 eyes of 36 patients undergoing intravitreal injections. Patients were randomized to treatment with additional topical proparacaine 0.5% versus control after undergoing informed consent. All patients prior to intravitreal injection underwent conjunctival culture after one drop of topical proparacaine 0.5% was placed. Half of patients then received an additional drop of proparacaine and then underwent a second conjunctival culture. The other half of patients had a drop of povidone iodine and then a second conjunctival culture. Intravitreal injection followed conjunctival cultures. To evaluate their experience, patients were provided with a survey., Results: In total, 36 patients were enrolled in the study. Three of 36 (8.3%) patients had positive conjunctival cultures after proparacaine eye drops alone. One of 17 (5.8%) patients had a positive conjunctival culture after a second drop of proparacaine. One of 19 (5.3%) patients had a positive culture after proparacaine and povidone iodine. By noninferiority analysis, proparacaine was inferior to povidone iodine ( p  = .28). Patient experience surveys did not differ between groups., Conclusion: Patient perception did not significantly differ whether or not additional proparacaine drops were used prior to intravitreal injection in a randomized controlled trial. While proparacaine has some antiseptic properties, these were found to be inferior to those of povidone iodine. Therefore, while povidone iodine is essential for antisepsis, additional proparacaine drops should not interfere with antisepsis.

Background: Previous studies of postoperative corneal injury rates relied on provider-initiated incident reports, which may underestimate the true incidence. Postoperative administration of proparacaine eye drops is used almost exclusively to diagnose corneal injury; therefore, identifying instances of administration may provide a better estimate of corneal injuries. We compared proparacaine administration versus provider-initiated reports to determine rates of corneal injury. In addition, potential associations between clinical variables and injury were assessed with a matched case-control study., Methods: The health records of 132,511 sequential adult postanesthesia recovery room admissions (January 1, 2011 to June 30, 2017) were reviewed to identify postoperative proparacaine administration and incident reports of corneal injury. Patients with corneal injury were matched with control patients at a 1:2 ratio to assess factors associated with injury., Results: Proparacaine drops were administered to 442 patients (425 patients received proparacaine for diagnosis and 17 patients received proparacaine for unrelated reasons). Incident reports identified 320 injuries, and the aggregate corneal injury count was 436 (incidence, 3.3 injuries [95% confidence interval {CI}, 3.0-3.6] per 1000 cases of general anesthesia). Proparacaine administration had a greater case ascertainment percentage than incident reporting (97.5% vs 73.4%; P < .001). The matched case-control analysis found greater risks associated with longer duration of anesthesia (odds ratio, 1.05 [95% CI, 1.03-1.07] per 10 minutes of anesthesia; P < .001) and nonsupine surgical position (odds ratio, 3.89 [95% CI, 2.17-6.98]; P < .001). Patients with injuries also had more evidence of sedation and agitation during anesthesia recovery., Conclusions: Calculation of incidence by using the administration of a medication (proparacaine eye drops) that is almost exclusively used to diagnose a specific injury (corneal injury) showed higher case ascertainment percentage than incident-reporting methods. Similar strategies could be used to monitor the rates of other adverse events.

Purpose: To measure IOP in animals, it is often necessary to use topical anesthetics. The use of these drugs may cause changes in IOP and interfere with the final results. To address this issue, the effects of four local anesthetics (tetracaine, proparacaine, lidocaine, and bupivacaine) on IOP were investigated in ten adult dogs., Methods: One drop of tetracaine was instilled in the right eye of half of the dogs and in the left eye of the other dogs; normal saline was instilled in the fellow eyes. The IOP in each dog was measured before and at 0, 5, 10, 15, 20, 25, 30, and 35 min after drug instillation using an electronic rebound tonometer. The effects of the other anesthetics were studied in the same way at intervals of at least 1 week., Results: After instillation of tetracaine, the IOP decreased gradually, such that after 15 min, the IOP was significantly lower than the baseline (p = 0.022) and control values (p = 0.048). Proparacaine also reduced IOP after 10 min compared to baseline values (p = 0.046), but the two other drugs, bupivacaine and lidocaine, had no significant effect on IOP. The duration of eye anesthesia was 16, 20, 22, and 34 min for tetracaine, lidocaine, bupivacaine, and proparacaine, respectively., Conclusion: We recommend using drugs that combine inducing longer anesthesia with producing the smallest change in IOP, such as bupivacaine and, subsequently, lidocaine. Tetracaine and proparacaine have a significant effect on IOP, and if these drugs are used, this effect should be considered.

The aim of the study was to investigate the analgesic effects of adding serotonin to oxybuprocaine or proxymetacaine preparations. We employed a rat model of the cutaneous trunci muscle reflex (CTMR) to conduct the dose-response curves and duration of drugs (oxybuprocaine, proxymetacaine, or serotonin) as an infiltrative anesthetic. The use of isobolographic methods to analyze the drug-drug interactions. We showed that oxybuprocaine and proxymetacaine, as well as serotonin produced dose-dependent skin antinociception. On the basis of 50% effective dose (ED 50 ), the rank order of drug potency was serotonin [7.22 (6.45-8.09) μmol/kg] < oxybuprocaine [1.03 (0.93-1.15) μmol/kg] < proxymetacaine [0.59 (0.53-0.66) μmol/kg] (P < 0.01 for each comparison). The sensory block duration of serotonin was longer (P < 0.01) than that of oxybuprocaine or proxymetacaine at the equipotent doses (ED 25 , ED 50 , and ED 75 ). The mixture of serotonin with oxybuprocaine or proxymetacaine produced a better analgesic effect than the drug itself. We have concluded that oxybuprocaine, proxymetacaine, or serotonin displays dose-related cutaneous analgesia. Oxybuprocaine or proxymetacaine is more potent and has a shorter duration of cutaneous analgesia than serotonin. Serotonin produces a synergistic antinociceptive interaction with oxybuprocaine or proxymetacaine., (Copyright © 2019 Elsevier B.V. All rights reserved.)

OBJECTIVE To evaluate the effects of topical ophthalmic application of 0.5% proparacaine hydrochloride solution (PHCL; containing 0.01% benzalkonium chloride as preservative) on aerobic bacterial culture results for naturally occurring infected corneal ulcers in dogs. DESIGN Clinical trial. ANIMALS 25 client-owned dogs with infected corneal ulcers (24 unilaterally affected and 1 bilaterally affected; only 1 eye included/dog) examined between June 2008 and May 2011. PROCEDURES Swab samples for aerobic bacterial culture were collected from the periphery of each corneal ulcer before and approximately 1 minute after topical ophthalmic application of 1 drop of PHCL. Numbers of aerobic bacterial species isolated from affected eyes were compared between sample collection points and between other variables (ie, side [left or right] of affected eye, prior treatments, and patient age, sex, and neuter status). RESULTS There was no significant difference between numbers of aerobic bacterial species isolated per eye or overall aerobic bacterial culture results (positive or negative) before versus after PHCL application. Similarly, prior treatment had no significant effect on aerobic bacterial culture results for samples collected at either point. The most commonly isolated bacteria before and after PHCL application were Staphylococcus spp (40% and 48%, respectively), followed by Streptococcus spp (23% and 22%, respectively). CONCLUSIONS AND CLINICAL RELEVANCE Topical ophthalmic application of PHCL did not significantly affect aerobic bacterial culture results for naturally occurring infected corneal ulcers in dogs as assessed in this study. Therefore, topical ophthalmic PHCL application could be useful in clinical settings prior to sample collection to relieve patient discomfort and to aid in sample acquisition without compromising aerobic bacterial culture results.

Significance: Pharmaceutical companies recommend discarding ophthalmic drugs 28 days after opening. This study shows that diagnostic eye drops have a low risk of contamination over a 7-month period in a controlled clinical setup. The diagnostic efficiency seems to be preserved over this period., Purpose: The aim of this study was to evaluate the preservation period and the efficacy of ophthalmic preparations, such as 0.5% proparacaine hydrochloride, 1% tropicamide, 2.5% phenylephrine hydrochloride, and 1% cyclopentolate hydrochloride ophthalmic solution in a clinical and controlled setting., Methods: Thirty-eight primary eye care students were recruited to participate in the study. They used 25 bottles of each diagnostic drop at the Clinique Universitaire de la Vision for a 7-month period. An analysis of the bacterial contamination was repeated 10 times using both an agar plate and a nutrient broth at 0, 2, 4, 6, and 8 weeks and at 3, 4, 5, 6, and 7 months. The anesthetic, mydriatic, and cycloplegic effects were tested after 7 months of use and compared with nonopened ophthalmic bottles., Results: During the 7-month period, 4971 drops of proparacaine, 3219 drops of tropicamide and phenylephrine, and 1896 drops of cyclopentolate were administered to the patients. A total of 226 contacts between bottles and biological tissues were reported. After the 10 inoculation sessions on the agar medium at the predetermined times, no bacterial and fungal contamination was noted. No patient reported eye infections for 2 weeks after the drop instillation. Moreover, there was no difference in the efficacy when compared with new drops., Conclusions: According to the results of the current study, diagnostic eye drops can be used with a low contamination risk beyond the recommendation date of 28 days up to 7 months, with the same efficacy, in a controlled clinical context.

Purpose: To investigate whether melanopsin-containing ophthalmic trigeminal ganglion cells provide significant input to mediate light-induced discomfort. This is done by studying the effect of ocular topical anesthesia on light-induced discomfort threshold to blue light and red light stimuli using a psychophysical approach., Method: Ten visually normal participants completed the experiment consisting of two trials: an anesthesia trial in which light stimuli were presented to both eyes following 0.5% proparacaine eye drops administration, and a placebo trial in which normal saline drops were used. In each trial, a randomized series of 280 blue and red light flashes were presented over seven intensity steps with 20 repetitions for each color and light intensity. Participants were instructed to report whether they perceived each stimulus as either "uncomfortably bright" or "not uncomfortably bright" by pressing a button. The proportion of "uncomfortable" responses was pooled to generate individual psychometric functions, from which 50% discomfort thresholds (defined as the light intensity at which the individuals perceived the stimulus to be uncomfortably bright/unpleasant 50% of the time) were calculated., Results: When blue light was presented, there was no significant difference in the light-induced discomfort thresholds between anesthesia and placebo trials (P = 0.44). Similarly, when red light was used, no significant difference in threshold values was found between the anesthesia and placebo trials (P = 0.28)., Conclusions: Ocular topical anesthesia does not alter the light-induced discomfort thresholds to either blue or red light, suggesting that the melanopsin-containing ophthalmic trigeminal ganglion cells provide little or no significant input in mediating light-induced discomfort under normal physiologic conditions.

Purpose: To evaluate the success rate of adjustable suture techniques in horizontal eye muscle surgery in children ≤15 years of age over a 19-year period by a single surgeon., Methods: The medical records of all consecutive patients in this age group who underwent horizontal eye muscle surgery from 1989 through 2012 were reviewed retrospectively. Patients were divided into two groups: those in whom a nonadjustable suture technique was used and those in whom adjustable sutures were used. The following data were collected: type of strabismus, preoperative measurements, postoperative results, and reoperation rates., Results: A total of 116 cases in the nonadjustable group and 521 cases in the adjustable group were included. In the adjustable group, adjustment was performed in 63% of the cases, because of either an under- (41%) or overcorrection (22%). The adjustment procedure was performed under topical proparacaine in 15% of cases and under intravenous propofol in 85%. For the adjustable group, 3-5 minutes more per muscle intraoperatively and 15-20 minutes for adjustment were required. No complications were encountered during the adjustment procedures. Early success rate, defined as alignment within 8 Δ of straight at 3 to 6 months' postoperative follow-up, was significantly greater in the adjustable group than in the nonadjustable group (77.7% vs 64.6% [P ≤ 0.03]). Of the adjustable patients, 15% required reoperation compared with 21% of the nonadjustable patients., Conclusions: Use of adjustable sutures in horizontal eye muscle surgery in children ≤15 years of age provided an improved success rate and fewer reoperations compared with nonadjustable sutures., (Copyright © 2018 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.)

Aim: To evaluate the effectiveness of bilateral use of topical anesthetic eye drops during phacoemulsification procedure as compared to use in one eye only., Methods: This is a prospective double-blind randomized case study of 180 cases undergoing phacoemulsification under topical anesthesia using 0.5% proparacaine: Group 1 consisting of patients who had topical anesthetic eye drop instilled into the operating eye only and Group 2 consisting of patients who had both their eyes anesthetized using topical anesthetic eye drops. Phacoemulsification was done using standard surgical technique. Main parameters evaluated included number of intra-operative patient counseling score (IPCS), surgical comfort score (SCS), total phacoemulsification procedure time (TPPT) and total operation time (TOPT)., Results: A comparison of mean value of various variables between Group 1 (60; 33.3% cases) and Group 2 (120; 66.7% cases) using "t" test revealed that there was a statistically significant difference for mean SCS (78.38 ± 10.31 vs. 85.05 ± 8.70; p = 0.00), mean IPCS (12.60 ± 3.11 vs. 6.63 ± 1.74; p = 0.00) and mean TOPT (418.88 ± 89.59 vs. 341.64 ± 79.51; p = 0.00), respectively. However, no statistically significant difference existed for mean TPPT (143.57 ± 87.96 vs. 152.96 ± 78.99; p = 0.48)., Conclusion: Simultaneous instillation of topical anesthetic eye drops in both the eyes, i.e., operating eye and the fellow eye as against practice of instilling topical anesthetic eye drop in the operating eye only, helps in decreasing the total surgical time by primarily shortening the durations of pre- and post-ultrasonic periods of surgery where effective globe stabilization is wanted. This is achieved by better patient compliance, which in turn enhances surgeon's comfort during phacoemulsification surgery.

Objective: To compare the safety and efficacy of topical anesthesia versus peribulbar anesthesia for 23-gauge pars plana vitrectomy., Study Design: Randomized controlled trial., Place and Duration of Study: Ophthalmology Department, Lahore General Hospital, Ameer-ud-Din Medical College, Postgraduate Medical Institute, Lahore from April 2013 to March 2016., Methodology: A total of 110 patients were equally divided (n=55) in group A (topical anesthesia) and group B (peribulbar anesthesia). In group A, pledget soaked with 0.5% proparacaine hydrochloride were placed in the superior and inferior fornices three minutes before surgery, and removed just before surgery. For group B patients, 3 ml of 0.5% bupivacaine was used for peribulbar anesthesia three minutes before surgery. Surgical time was noted from the placement of pledget in fornix till the eye pad placed in group A, and from the time of peribulbar anesthesia in group B till the eye pad placed at the end of surgery. All data was recorded in Excel sheet and p-values were calculated using online OpenEpi., Results: The mean age of the patient was 56.28 ±13.76 years. Male patients were 78 (70.9%) and female patients were 32 (29.1%). Mean duration of surgery was 30.32 ±7.07 minutes and mean pain score was 2.30 ±0.98. There was a significant difference with respect to mean duration of surgery in patients who were given topical anesthesia (32.52 ±6.92 minutes) versus those given peribulbar anesthesia (28.12 ±6.57 minutes, p<0.001). Mean pain score in topical anesthesia group (3.11 ±0.89) was significantly higher as compared to peribulbar anesthesia group (2.67 ±0.91, p=0.011)., Conclusion: Topical anesthesia is as effective as peribulbar anesthesia in terms of patient comfort and duration of surgery for 23-G pars plana vitrectomy in patients with vitreous hemorrhage.

Background: We evaluated the interaction of dopamine-proxymetacaine and dopamine- oxybuprocaine antinociception using isobolograms., Methods: This experiment uses subcutaneous drug (proxymetacaine, oxybuprocaine, and dopamine) injections under the skin of the rat's back, thus simulating infiltration blocks. The dose-related antinociceptive curves of proxymetacaine and oxybuprocaine alone and in combination with dopamine were constructed, and then the antinociceptive interactions between the local anesthetic and dopamine were analyzed using isobolograms., Results: Subcutaneous proxymetacaine, oxybuprocaine, and dopamine produced a sensory block to local skin pinpricks in a dose-dependent fashion. The rank order of potency was proxymetacaine (0.57 [0.52-0.63] μmol/kg) > oxybuprocaine (1.05 [0.96-1.15] μmol/kg) > dopamine (165 [154-177] μmol/kg; P < .01 for each comparison) based on the 50% effective dose values. On the equianesthetic basis (25% effective dose, 50% effective dose, and 75% effective dose), the nociceptive block duration of proxymetacaine or oxybuprocaine was shorter than that of dopamine (P < .01). Oxybuprocaine or proxymetacaine coinjected with dopamine elicited a synergistic antinociceptive effect and extended the duration of action., Conclusions: Oxybuprocaine and proxymetacaine had a higher potency and provoked a shorter duration of sensory block compared with dopamine. The use of dopamine increased the quality and duration of skin antinociception caused by oxybuprocaine and proxymetacaine.

Proparacaine, one of the most common local anesthetics to facilitate diagnosis and treatment of eye diseases, was assayed by square wave voltammetry using a paste electrode prepared with carbon nanotubes. In cyclic voltammetric studies, proparacaine has exhibited a single irreversible anodic peak at around + 900 mV vs. Ag/AgCl in pH 6.0 Britton-Robinson buffer solution. It was suggested that the peak had appeared due to the oxidation of the NH 2 group on the proparacaine molecule. Prior to the determination of the proparacaine by square wave stripping voltammetry (SWSV) on the fabricated multi-walled carbon nanotube paste electrode (MWCNTPE), the accumulation potential (E acc ), accumulation time (t acc ), pulse amplitude (ΔE), step potential (ΔE s ) and frequency (f ) parameters were optimized. The peak currents plotted in the range of 0.5 - 12.5 mg/L proparacaine exhibited two linear sections with a detection limit of 0.11 mg/L. The results for the determination of proparacaine on a pharmaceutical local anesthetic (Alcaine ® ) showed that relative standard deviation (RSD) and relative error (RE) were 4.1 and -2.0%, respectively. Selectivity has also been investigated and results showed recoveries of 5.0 mg/L proparacaine in the presence of 5.0 mg/L dopamine, ascorbic acid and uric acid as 106.9 ± 0.8, 99.9 ± 1.2 and 94.1 ± 0.7, respectively.

Purpose: To investigate effect of topical anaesthetic (TA) during gas permeable (GP) contact lens (CL) fitting on subjective and objective measures of patient anxiety., Methods: 47 subjects (mean±sd age=26.9±4.9years; soft CL wearers, 18, neophytes, 29). Each subject randomly assigned to Group A or B, and attended on two occasions, one week apart. First visit: subject received bilaterally either a single drop of TA (0.5% proxymetacaine) (Group A) or placebo (0.9% saline) (Group B) prior to GP CL application. No drops were instilled at second visit. Each visit mimicked a GP CL fitting. At each visit, patient anxiety was assessed either subjectively (visual analogue scale (VAS)) or objectively (skin conductance (SC)), as well as anterior ocular health., Results: Visit 1: GP CL trial produced small increases in hyperaemia and corneal staining, but no difference associated with TA use. Visit 2: increases in staining and hyperaemia were observed, but hyperaemic responses significantly less than at Visit 1, for both groups. Corneal staining also less, but not statistically significant. VAS scores indicated subjects who received TA during Visit 1 were significantly less anxious at Visit 2. Visit 2: comfort slightly reduced for subjects who received TA at Visit 1, and significantly increased for subjects who received placebo. Use of TA reduced anxiety during lens adaptation period compared with subjects receiving placebo., Conclusions: TA use during GP CL fitting has potential patient benefits: improved first-time GP CL wear comfort, reduced anxiety during adaptation, reduced anxiety prior to subsequent GP CL wear., (Copyright © 2017 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Objective: To evaluate how closely neuropathic-like ocular pain (NOP) symptoms align with a metric of central sensitisation (ie, the presence of persistent ocular pain after topical anaesthetic placement) in individuals with dry eye (DE) symptoms., Design: Cross-sectional study of 224 individuals with DE symptoms seen in the Miami Veterans Affairs eye clinic. An evaluation was performed consisting of questionnaires regarding DE symptoms, NOP descriptors and evoked pain sensitivity testing on the forehead and forearm, followed by a comprehensive ocular surface examination including corneal mechanical sensitivity testing. Subsequent analyses were performed to examine for differences between those with and without ocular pain after topical anaesthetic placement., Results: The mean age was 62 years with 91% being men. DE symptoms and NOP symptoms were higher in subjects with persistent ocular pain after anaesthesia. Most DE signs were not related to persistent pain, with the exception of meibum quality. Individuals with persistent ocular pain also demonstrated greater sensitivity to evoked pain at testing sites on the forehead and forearm. When examining receiver operator characteristic curves considering persistent pain as a gold standard for central sensitisation within the corneal pathway, intensity of ocular pain ratings, Ocular Surface Disease Index scores and sensitivity to light provided the most robust relationships, each with an area under the curve of 0.72., Conclusions: Individuals with DE symptoms and persistent ocular pain after topical proparacaine (a marker of central sensitisation to pain) more frequently report NOP-like symptoms and demonstrate increased sensitivity to evoked pain., Competing Interests: Competing interests: None declared., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Objective: To compare the degree and duration of corneal anesthesia of a novel viscous ophthalmic lidocaine hydrochloride preparation vs. two commonly used ophthalmic anesthetic preparations., Methods: Each subject was randomly selected to receive 2 of 4 treatments at 2 different time periods separated by a 1 week washout: 3.5% lidocaine hydrochloride gel (Akten ® ; Akorn Inc., Lake Forest, Illinois, USA), 0.5% aqueous proparacaine hydrochloride (Akorn Inc.), 0.5% viscous tetracaine hydrochloride (TetraVisc™; Ocusoft Inc., Richmond, Texas, USA), or 0.9% saline eyewash as a negative control. Corneal sensitivity was determined using a Cochet-Bonnet aesthesiometer (Luneau ® , Chartres Cedex, France) prior to instillation of each treatment; at 1 and 5 min post treatment; and at 5-min intervals thereafter for 90 min total. Ocular side effects were recorded on a scale of 0-3., Results: Twenty-four normal dogs (48 eyes) were entered into the study. Mean duration of maximal anesthesia was significantly greater at 34.2 min with tetracaine compared to 21.5 min and 19 min with proparacaine and lidocaine respectively. Corneal sensitivity was significantly decreased from baseline for up to 70 min with tetracaine and 55 min with both proparacaine and lidocaine. All lidocaine-treated eyes had transient blepharospasm and conjunctival hyperemia. Ten out of 24 tetracaine-treated eyes had conjunctival hyperemia with 4 of these having concurrent chemosis., Conclusions: Tetracaine provided a significantly longer duration of corneal anesthesia than proparacaine or lidocaine. Tetracaine and lidocaine were associated with more ocular side effects than proparacaine, although these were mild and transient. None., (© 2016 American College of Veterinary Ophthalmologists.)

Purpose: To study the contribution of each eye to the reflex tear response, after unilateral and bilateral topical anesthesia., Method: A closed-eye, modified Schirmer test was performed bilaterally in 8 normal subjects, in a controlled environment chamber set to 23°C, 45% relative humidity, and 0.08 m/s airflow. Eye drops were instilled into each eye 10 minutes before the Schirmer test. Experiments were as follows: 1) bilateral saline (control), 2) unilateral anesthesia (ipsilateral anesthetic; contralateral saline), and 3) bilateral anesthesia., Results: There was no difference in between-eye wetting lengths in the saline control eyes (P = 0.394) or the bilaterally anesthetized eyes (P = 0.171). The wetting length was reduced in both eyes after bilateral anesthesia compared with saline controls (P = 0.001; P ≤ 0.0005). After unilateral anesthesia, the wetting length was reduced in the anesthetized eye compared with its saline control by 51.4% (P ≤ 0.0005) and compared with its fellow, unanesthetized eye (P = 0.005). The fellow eye value was also reduced compared with its saline control (P = 0.06)., Conclusions: The wetting length was reduced by topical anesthesia, when instilled bilaterally and ipsilaterally. The latter response implies an ipsilateral, reflex sensory drive to lacrimal secretion. In the unanesthetized fellow eye, the reduction compared with its saline control was not quite significant. This implies a relative lack of central, sensory, reflex cross-innervation, although the possibility cannot entirely be ruled out. These results are relevant to the possibility of reflex lacrimal compensation from a normal fellow eye, in cases of unilateral corneal anesthesia.

Background: The aim of this experiment was to investigate the interaction between epinephrine and 2 local anesthetics (proxymetacaine or oxybuprocaine) using subcutaneous injections under the hairy skin, thereby simulating infiltration blocks., Methods: Using a rat model of cutaneous trunci muscle reflex in response to local skin pinpricks, the anesthetic properties of proxymetacaine and oxybuprocaine alone and in combination with epinephrine as an infiltrative anesthetic were tested. Isobolographic analysis was used for the analgesic interactions between adjuvant epinephrine and the local anesthetics. Lidocaine was used as a control group., Results: Oxybuprocaine, proxymetacaine, and lidocaine elicited a dose-dependent block to pinpricks. On the 50% effective dose (ED50) basis, their relative potencies were proxymetacaine [0.126 (0.113-0.141) μmol] greater than oxybuprocaine [0.208 (0.192-0.226) μmol] greater than lidocaine [6.331 (5.662-7.079) μmol] (P < 0.01 for each comparison). On an equipotent basis (ED25, ED50, and ED75), sensory block duration elicited by oxybuprocaine or proxymetacaine was greater than that elicited by lidocaine (P < 0.01). Coadministration of proxymetacaine, oxybuprocaine, or lidocaine with epinephrine produced a synergistic analgesic effect and prolonged the cutaneous analgesic effect. After adding epinephrine, oxybuprocaine was much faster, reaching its maximal blockade, than proxymetacaine or lidocaine (P < 0.01)., Conclusions: We concluded that proxymetacaine and oxybuprocaine were more potent and produced greater duration of nociceptive block than lidocaine. The use of epinephrine augmented the potency and prolonged the duration of proxymetacaine, oxybuprocaine, and lidocaine as an infiltrative anesthetic.

Objectives: The use of corneal anaesthesia is necessary for a range of clinical purposes. Therefore, we assessed and compared the efficacy of corneal anaesthesia after application of 0.4% oxybuprocaine hydrochloride and 0.5% proparacaine hydrochloride ophthalmic solution in clinically normal cattle., Methods: The 24 clinically normal cows were allocated into two groups. Cows in group 1 (n = 12) received 0.2 mL of 0.4% oxybuprocaine hydrochloride with fluorescein ophthalmic solution in one eye and 0.2 mL of sterile saline (0.9% NaCl) with fluorescein in the contralateral eye (control). Group 2 (n = 12) received 0.2 mL of 0.4% oxybuprocaine hydrochloride with fluorescein ophthalmic solution in one eye and 0.2 mL of 0.5% proparacaine hydrochloride with fluorescein in the contralateral eye (control). In each group, corneal touch threshold was determined by Cochet-Bonnet aesthesiometer for both eyes immediately prior to topical administration of solutions, at 1 min and 5 min after administration of topical solutions and every 5 min thereafter for a total of 75 min., Results: Significant corneal anaesthesia was noted immediately following topical application of both oxybuprocaine and proparacaine as compared with controls, with maximal corneal anaesthesia noted 1 min after administration. Both oxybuprocaine and proparacaine produced significant corneal anaesthesia for the duration of the 75-min study. Neither oxybuprocaine hydrochloride nor proparacaine hydrochloride treatment resulted in visible adverse effects., Conclusion: There are limited data available demonstrating the efficacy and duration of corneal anaesthetic agents in cattle. Both oxybuprocaine hydrochloride and proparacaine hydrochloride should be considered practical options for providing corneal anaesthesia in cattle in a clinical setting., (© 2016 Australian Veterinary Association.)

The American Academy of Pediatrics advocates efforts to minimize discomfort and systemic effect of retinopathy of prematurity (ROP) examinations. Although many ophthalmologists use topical anesthetics, many do not believe them necessary. We present the results of the first survey to quantify the use of topical anesthetics in ROP examinations by clinicians who screen for ROP. The results show that although use of topical anesthetic is common, it is not universal., (Copyright © 2016 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.)

Objective: To investigate the efficacy of paracetamol in reducing pain during examination for retinopathy of prematurity (ROP) in preterm infants., Methods: A total of 114 infants undergoing eye examination for retinopathy of prematurity screening were prospectively randomized. Topical anesthetic (Proparacaine; Alcaine® drop 0.5%) was applied 30 s before the eye examination in all the infants. The infants in the intervention group (Group 1, n = 58) received 15 mg/kg of oral paracetamol, 60 min before the examination. The control group (Group 2, n = 56) received the same volume of sterile water per oral with an opaque syringe. Primary outcome measurement was pain assessed by Premature Infant Pain Profile (PIPP) score. Secondary outcome measurements were tachycardia (>180 bpm)/bradycardia (<100 bpm), desaturations (<85% for >10 s), and crying time., Results: The groups were similar for gestational age, birthweight or postnatal age at examination. The intervention group had a significantly lower mean PIPP score during eye examination, following insertion of the speculum [Group 1:12 (9-13) vs. Group 2:14 (13-15), p 0.001]. There were no significant differences between the groups with regard to crying time and the number of the patients with tachycardia/bradycardia and desaturation., Conclusions: Oral paracetamol modestly reduces pain scores during eye examinations. Further cross-over trials on dose and frequency of paracetamol and combination of pharmacological with non-pharmacological approaches and paracetamol alone as a single agent in significant pain reduction are needed.

Purpose: To determine the psychological effects of eyedrops administration in children., Methods: Children requiring eyedrops for cycloplegic refraction were recruited in this cross-sectional study. Nurses administered eyedrops in 2-3 cycles spaced 5-10 minutes apart, and optometrists performed refraction 30 minutes after the last drop. Ophthalmologists, nurses, and optometrists rated the children's cooperation level at first review, after each eyedrop, at refraction, and at final review. Parents chose a personality type best describing their child, and monitored their child's anxiety using a modified Yale Preoperative Anxiety Scale (m-YPAS). Children were "uncooperative" if nurses noted significant distress during the first drop cycle., Results: A total of 298 children 2-12 years of age were included. Of these, 77 (26%) experienced pre-drop distress and 39 (13%) were uncooperative with drops. Compared to cooperative children, uncooperative children tended to be younger (2.0-4.9 years vs ≥8 years; OR, 4.11; 95% CI, 1.14-14.83; P = 0.031), male (OR, 2.55; 95% CI, 1.06-6.10; P = 0.036), have had a previous negative eyedrop experience (84.2% vs 25.3%; P < 0.001) and were more anxious (m-YPAS scores, 41.4 ± 22.0 vs 30.6 ± 12.6: P < 0.001). Children described as "demanding and aggressive" were more uncooperative than "timid and anxious" children. It took longer to instill drops (3.1 vs 1.3 minutes), and perform refraction (11.6 vs 7.2 minutes) in uncooperative children., Conclusions: A small group of children were uncooperative with eyedrops and 26% experienced significant pre-drop anxiety. Factors such as age, sex, a previous negative eyedrop experience, and pre-drop anxiety, associated with uncooperativeness need to be considered when developing strategies to improve the eyedrops experience in children., (Copyright © 2015 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.)

Objective: To assess the effectiveness of expressed breast milk (EBM) on neonatal pain during screening for retinopathy of prematurity (ROP)., Methods: Neonates who were on oral feeds undergoing ROP screening were included. Babies were randomized into intervention group (EBM + Standard practice) and control group. The standard practice is proparacaine, nesting and swaddling. Pain was assessed by PIPP scale, during and at 1 and 5 min after the procedure by the principal investigator who was blinded., Results: The groups were similar in baseline characteristics. The group receiving EBM had significantly lower PIPP scores during the procedure 12.7 ± 1.69 compared to the control group 15.5 ± 1.78 (p < 0.05). The beneficial effect persisted at 1 min and 5 min after the procedure 6.20 ± 1.9 vs. 12.4 ± 2.54 (p ≤ 0.05) at 1 min; 3.2 ± 1.5 and 6.85 ± 2.4 (p < 0.05) at 5 min., Conclusion: Oral EBM significantly reduces pain during and after ROP screening., (© The Author [2014]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Objective: Compare efficacy of 0.5% proparacaine eye drops and oral 25% dextrose in reducing pain during screening for retinopathy of prematurity (ROP)., Patients and Methods: Double-blinded randomized controlled trial. Twenty eligible babies were randomized. Group I received 0.5% proparacaine eye drops at first ROP screening, while Group II received 25% dextrose orally. At second examination, babies received no intervention. Pain was assessed using Premature Infant Pain Profile (PIPP) score., Results: The mean ( ± SD) PIPP during procedure in Group I were 15.5 ± 2.06 and 14 ± 2.4 at first and second screening (p = 0.259). The mean ( ± SD) PIPP in Group II were 14.2 ± 1. 8 and 14.9 ± 2.5 at the first and second screening (p = 0.428). Differences were not statistically significant. The PIPP scores of Group I and Group II at the first screening were also not significantly different (p = 0.165)., Conclusion: ROP screening causes moderate to severe pain and neither proparacaine nor dextrose is an effective analgesic., (© The Author [2014]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Purpose: To compare the anesthetic effectiveness of topical proparacaine drops, subconjunctival lidocaine, and 2% lidocaine gel., Methods: Ninety-two patients undergoing intravitreal injections were randomized to 1 of 3 groups: proparacaine 0.5% drops (Group Drops), proparacaine 0.5% drops plus subconjunctival lidocaine (Group SC), or 2% lidocaine gel (Group Gel). Patients were asked to score their pain experience using a visual analog scale of 0 to 10 immediately following the injections and 10 min, 1 h, 6 h, and 24 h after the injections. Patients also graded the overall injection experience as Excellent, Very Good, Fair, Poor, or Awful. The physician evaluated the patients' eye movement during intravitreal injection on 3 levels: (0) none or minimal, (1) not compromising the injection, and (2) compromising the injection., Results: The patients in Group Drops had the worst mean pain scores during the injection and 10 min after, with the highest occurrence of movements compromising the procedure (Grade 2; 38.7%). The patients in Group SC had a higher percentage of good experiences (37.9%) but a higher incidence of chemosis (16.7%). The patients in Group Gel had similar overall pain scores to Group Drops patients but a higher incidence of keratitis (19.4%). There was no statistically significant correlation between the use of aspirin or anticoagulants and the occurrence of hyperemia or hyposphagma., Conclusion: Subconjunctival lidocaine was most effective in preventing pain and eye movements during intravitreal injections. Although 2% lidocaine gel produced a good overall experience for the patients, the incidence of keratitis was very high (19.4%). Therefore, we do not recommend 2% lidocaine gel as the first anesthetic choice for intravitreal injections. There is no evidence to suspend the use of aspirin or other anticoagulants drugs prior to intravitreal injections.

Measurement of intraocular pressure (IOP) in children is important in the management of pediatric glaucoma. Availability of the Icare rebound tonometer has greatly facilitated our ability to obtain awake IOP in infants and children, but little has been reported on either the effect of repeated sequential IOP measurements with Icare or the effect of topical anesthetic on subsequent Icare tonometry. This prospective study of 20 eyes of 10 cooperative children (12 normal eyes, 8 with suspected or known glaucoma) found that neither 8 sequential Icare measurements nor application of topical anesthetic produced a statistically or clinically signficant change in measured IOP by rebound tonometry., (Copyright © 2014 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.)

Aim: To compare the efficacy and safety of 0.5% intracameral lignocaine to 1% intracameral lignocaine prior to phacotrabeculectomy., Study Design: Prospective, comparative, observational, and interventional study., Setting: Tertiary eye care center in central India., Materials and Methods: This study was comprised of 79 patients (79 eyes) with primary open angle glaucoma scheduled for phacotrabeculectomy. Patients were assigned to 1 of 2 Groups receiving proparacaine 0.5% eye drops and 1% intracameral lignocaine just prior to phacotrabeculectomy (Group 1, n = 39) and 0.5% intracameral lignocaine after completion of phacoemulsification just prior to trabeculectomy (Group 2, n = 40). The visual analogue scale was used to record intraoperative and postoperative pain. Patient comfort, intraoperative painful sensations perceived by the patient, supplemental anesthesia, complications, and surgeon discomfort were noted. An anesthetist also noted the vital parameters and the requirement for intravenous medications., Results: There was no significant difference in the intraoperative pain score (P = 0.0733) or supplemental anesthesia (P = 0.372) between Groups. Postoperative pain score was statistically significant in Group 2 (P < 0.0001). The overall operating conditions in both Groups were comparable (P = 0.7389). A greater number of patients in Group 2 (88.57%) preferred the same anesthetic technique for combined surgery in the fellow eye. There was no difference in inadvertent eye movements and lid squeezing between Groups and they did not interfere with surgery., Conclusion: Topical anesthetic drops supplemented with 0.5% intracameral lignocaine before performing trabeculectomy is as effective as 1% intracameral lignocaine given at the beginning of phacotrabeculectomy for primary open angle glaucoma.

Purpose: The aim of this study is to evaluate the effect of early amniotic membrane transplantation (AMT) in patients with topical proparacaine-related toxic keratopathy., Materials and Methods: Between 2008 and 2011, eight eyes of seven patients with toxic keratopathy related to 0.5% proparacaine abuse underwent early AMT (within 1 to 5 days following the diagnosis). Clinical findings and treatment outcomes of these cases were evaluated retrospectively., Results: The median time of topical anesthetic abuse until admission to our clinic was 28 (10-112) days. One case was referred due to achanthamoeba keratitis; two cases due to intractable corneal ulcer and melting. At initial examination, visual acuities varied between hand motions and 0.4 (in decimal notation). Biomicroscopic evaluation at presentation revealed epithelial defects, corneal ulcers, stromal ring infiltrate, stromal edema and corneal melting with varying degrees. At third month after AMT, the visual acuities varied between hand motions and 0.9, and all the patients had corneal stromal opacities with varying densities. One patient, who did not respond to medical and surgical treatment and developed secondary infections that invaded intraocular structures, underwent evisceration., Conclusion: Topical anesthetic abuse can lead to serious ocular complications. After proper diagnosis, the first step of treatment is the cessation of drug abuse. In addition to medical treatment, early AMT has an advantage of early pain relief and consequential elimination of the need for topical anesthetic instillation.

Purpose: The purpose of this study was to compare the efficacy of a single drop of 0.5% proparacaine hydrochloride in uncomplicated cataract surgery with phacoemulsification., Materials and Methods: Two hundred and ninety five patients scheduled for the phacoemulsification were divided into 2 groups based on the anesthetic agents they were to receive: 146 patients who received a single drop of 0.5% proparacaine 2 min before the start of the surgery (proparacaine group) and; 149 patients who received supplementation of 0.5% intracameral preservative free xylocaine (xylocaine group). A single surgeon performed all surgeries. Intraoperative and post-operative pain scores were evaluated on a visual analog scale. The surgeon noted his subjective impression of corneal clarity, discomfort while performing the surgery any supplemental anesthesia required and intraoperative complications. An anesthetist noted vital parameters and the need for intravenous sedation. Total surgical time was noted. Comparison of parameters was performed with the Chi-square test, and A P value less than 0.05 was considered as statistically significant., Results: No statistically significant difference was seen in the intraoperative (P = 0.24) and post-operative (P = 0.164) pain scores between groups. There was no pain (0 score) in 41.8% of patients in the proparacaine group and 46.3% of patients in the xylocaine group. The average surgical time (P = 0.279) and surgeon discomfort (P = 0.07) were not statistically significantly different between groups. No patients required supplemental anesthesia. There were no surgical complications that could compromise the visual outcome. An equal number of patients in both groups preferred same type of anesthetic technique for the fellow eye cataract surgery (89.11% for the proparacaine group and 90.18% for the xylocaine group). No patients in either group had changes in vital parameters or required intravenous sedation., Conclusion: A single drop pre-operatively, of proparacaine hydrochloride was comparable to the intracameral supplementation of preservative free xylocaine for phacoemulsification in uncomplicated cataract surgery without compromising the visual outcome. However, we recommend individualizing the anesthetic technique according to the requirements of the surgeon.

We conducted a randomised trial comparing lidocaine 2% gel with proparacaine 0.5% eye drops in children having elective squint surgery. One hundred and forty children aged between 3 and 14 years were recruited. The requirement for intra-operative fentanyl and postoperative ibuprofen was significantly less in the lidocaine group compared with the proparacaine group (1 (1.7%) vs 12 (18.5%), p=0.002 and 16 (27.6%) 38 (58.5%), p=0.001, respectively). The incidence of postoperative nausea and vomiting was significantly less in the lidocaine group compared with the proparacaine group (6 (10.3%) vs 16 (24.6%), p=0.04). There were no differences between the groups in terms of incidence and severity of the oculocardiac reflex. We conclude that, compared with proparacaine 0.5% eye drops, a single application of lidocaine 2% gel improves peri-operative analgesia and reduces the incidence of postoperative nausea and vomiting in elective paediatric squint surgery., (Anaesthesia © 2013 The Association of Anaesthetists of Great Britain and Ireland.)

A 72-year-old man was admitted to our clinic because of pain in the right eye. Corneal oedema, peripheral anterior synechiae formation and intraocular lens were determined in the right eye. The left eye was normal except for nuclear sclerosis. Intraocular pressure was 35 mm Hg in the right eye and 14 mm Hg in the left eye. The patient was diagnosed as having bullous keratopathy and glaucoma. He was treated with antiglaucoma drugs and artificial tears as an outpatient. Persistent keratopathy was observed at follow-up, despite adequate therapy. In the detailed anamnesis of the patient, we discovered that he had used a topical anaesthetic instead of the prescribed medicine owing to ocular pain. The patient was still using topical anaesthetic eye drops, despite warnings. Finally, evisceration was performed on his right eye because of corneal melting and perforation.

Objective: To compare efficacy and duration of effect on corneal sensitivity of 0.5% proparacaine hydrochloride, 0.5% bupivacaine hydrochloride, 2% lidocaine hydrochloride, and 2% mepivacaine hydrochloride solutions following ocular administration in clinically normal horses., Animals: 68 clinically normal horses., Procedures: 60 horses were assigned to receive 1 anesthetic agent in 1 eye. For each of another 8 horses, 1 eye was treated with each of the anesthetic agents in random order with a 1-week washout period between treatments. Corneal sensitivity was assessed via corneal touch threshold (CTT) measurements obtained with a Cochet-Bonnet aesthesiometer before and at 1 minute, at 5-minute intervals from 5 to 60 minutes, and at 10-minute intervals from 60 to 90 minutes after application of 0.2 mL of anesthetic agent. General linear mixed models were fitted to the CTT data from each of the 2 experimental groups to assess the effects of the anesthetic agents over time, accounting for repeated observations within individual horses., Results: Corneal sensitivity decreased immediately following topical application of each anesthetic agent; effects persisted for 35 minutes for proparacaine and mepivacaine treatments, 45 minutes for lidocaine treatment, and 60 minutes for bupivacaine treatment. Maximal CTT reduction was achieved following application of bupivacaine or proparacaine solution, whereas mepivacaine solution was least effective., Conclusions and Clinical Relevance: Ocular application of each evaluated anesthetic agent reduced corneal sensitivity in horses; although 0.5% proparacaine or 2% lidocaine solution appeared to induce adequate short-duration corneal anesthesia, use of 0.5% bupivacaine solution may be more appropriate for procedures requiring longer periods of corneal anesthesia.

Objective: To compare the corneal anesthetic effects and duration of action of 2 ophthalmic anesthetic agents in horses., Design: Prospective, randomized masked crossover study., Animals: 8 clinically normal adult horses., Procedures: Corneal sensitivity was determined by measuring each eye's corneal touch threshold (CTT) with a Cochet-Bonnet esthesiometer. Each eye's baseline CTT was recorded prior to anesthetic instillation at 0 minutes and every 10 minutes thereafter for 60 minutes. Each eye was randomly assigned to receive 2 of 4 treatments: 0.5% aqueous proparacaine ophthalmic solution (aqueous proparacaine; 8 eyes); 0.5% aqueous tetracaine ophthalmic solution (aqueous tetracaine; 8 eyes); 0.5% viscous tetracaine ophthalmic solution (viscous tetracaine; 8 eyes); and saline (0.9% NaCl) eyewash solution (8 eyes) as a negative control. There was a 48-hour washout period. Every horse received all treatments., Results: Median baseline CTT of eyes was 4.5 cm (range, 0.5 to 6 cm). Median CTT for saline solution-treated eyes never differed significantly from baseline. The maximum anesthetic effect with the other 3 treatments occurred at 10 minutes. Median CTT of eyes at 10 minutes was 0.5 cm (range, 0 to 2.5 cm) with aqueous proparacaine treatment, 0.25 cm (range, 0 to 2.0 cm) with aqueous tetracaine treatment, and 0 cm (range, 0 to 0.5 cm) with viscous tetracaine treatment. Maximum anesthetic duration was 20 minutes with aqueous proparacaine and aqueous tetracaine treatments and 30 minutes with viscous tetracaine treatments., Conclusions and Clinical Relevance: Treatment of eyes with viscous tetracaine resulted in the greatest decrease in CTT and the longest duration of action, compared with treatment with aqueous proparacaine or aqueous tetracaine.

To evaluate the use of combined topical and intracameral anesthesia for Descemet's stripping automated keratoplasty (DSAEK). This was a retrospective comparative cohort analysis consisting of 10 eyes in 10 consecutive patients undergoing DSAEK surgery with combined topical and intracameral anesthesia. These cases were compared with 21 randomly selected controls during the same time period undergoing DSAEK surgery performed under retrobulbar anesthesia. Incidence of intraoperative and postoperative complications, and endothelial cell counts were compared. In all cases, DSAEK was completed without intraoperative complications. All patients tolerated the procedure well. There were 6 cases of postoperative graft dislocation requiring rebubbling, and no cases of primary failure or endophthalmitis. No significant difference in endothelial cell counts was found at final follow-up. Short-term results suggest that combined topical and intracameral anesthesia is as safe and effective for DSAEK in cooperative patients when compared to retrobulbar anesthesia. It may thereby be an alternative anesthetic modality for patients in whom retrobulbar or peribulbar anesthesia may be risky or contraindicated.