Intracameral anesthesia: in vitro iris and corneal uptake and washout of 1% lidocaine hydrochloride

Arch Ophthalmol. 1999 Feb;117(2):225-32. doi: 10.1001/archopht.117.2.225.

Abstract

Objectives: To characterize the uptake, washout, and metabolism of lidocaine hydrochloride in the iris/ciliary body and cornea.

Methods: Iris/ciliary body uptake of lidocaine hydrochloride was measured by incubating human and rabbit irides in radiolabeled carbon 14-1% lidocaine hydrochloride for 2 to 60 minutes. Washout was determined by incubating the iris in 14C-1% lidocaine hydrochloride for 5 minutes and transferring the iris to a series of wells. The wells contained a common intraocular irrigating solution of essential ions, glucose, and glutathione buffered with bicarbonate (an enriched balanced salt solution [BSS PLUS]), which is similar to aqueous humor. Corneal uptake was measured by exposing the endothelial surface to 14C-1% lidocaine hydrochloride for 5 or 15 minutes. Corneal washout was performed after 5-minute exposure to 14C-1% lidocaine hydrochloride using a 2-chambered diffusion apparatus. Samples of the iris, cornea, and BSS PLUS washout solution were analyzed by high-performance liquid chromatography and liquid scintillation spectrometry.

Results: In vitro iris/ciliary body uptake of 14C-1% lidocaine hydrochloride follows a logarithmic curve, with 50% to 60% of maximum lidocaine hydrochloride uptake present at 5 minutes. There was no difference in uptake between human, albino rabbit, and pigmented rabbit irides. Washout of lidocaine from the iris occurs with a halflife of 8 to 9 minutes. Corneal uptake of lidocaine was greater after incubation for 15 vs. 5 minutes. The washout of lidocaine from the cornea had a half-life of 5 minutes. Results of high-performance liquid chromatography confirmed that there were no metabolites or breakdown products in the iris, cornea, or washout solution.

Conclusions: Lidocaine is taken up quickly by the iris/ ciliary body and cornea and rapidly removed from these tissues after BSS PLUS washout. Irrigation during phacoemulsification seems to limit lidocaine exposure to the ocular tissues, resulting in a short duration of anesthesia. Lidocaine is not metabolized or broken down by the iris or cornea during this short period.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Anesthesia, Local*
  • Anesthetics, Local / metabolism
  • Anesthetics, Local / pharmacokinetics*
  • Animals
  • Anterior Chamber / metabolism
  • Chromatography, High Pressure Liquid
  • Ciliary Body / metabolism*
  • Cornea / metabolism*
  • Half-Life
  • Humans
  • Iris / metabolism*
  • Lidocaine / metabolism
  • Lidocaine / pharmacokinetics*
  • Middle Aged
  • Rabbits

Substances

  • Anesthetics, Local
  • Lidocaine