Beware potential complications with intracameral medications

CHICAGO — Intracameral lidocaine and steroids are effective adjuncts in cataract surgery only if the surgeon pays strict attention to both timing and concentration, said James P. Gills, MD, here at the American Academy of Ophthalmology meeting.

“If either lidocaine or steroids are left in the eye for a long period of time, you could end up with toxic anterior segment syndrome [TASS],” Dr. Gills said. His research team at the University of South Florida has “only observed TASS in patients who received intraocular lidocaine,” he said.

He has been using intraocular lidocaine in cataract surgery since 1991 and began using it routinely in 1995, he said.

“Like all medications, it’s great in proper dilutions,” he said.

With experience now close to 50,000 cases in which intracameral injection of triamcinolone acetonide was used, Dr. Gills said he has found the effective dosage to hover around 0.5 mg.

“Using Kenalog (triamcinolone acetonide, Bristol-Myers Squibb), we saw less endothelial cell loss with dilution and ascorbic acid,” he said.

He warned that Kenalog “decreases the ability of the eye to fight infection” if left in the eye for too long.

Dr. Gills said cataract patients with Fuchs’ dystrophy “did better with intraocular Kenalog; only 10% needed a transplant post surgery.”

In general, he said, blurred vision may be a complication of Kenalog use even if the patient’s visual acuity is 20/20.

“Always consider the dosage and time in the eye,” he said. “Use intracameral medications, but carefully and judiciously.”