Intracameral anesthetics in cataract surgery and its toxicity to the cornea – a review
DOI:
https://doi.org/10.34119/bjhrv8n3-265Keywords:
anestésicos, catarata, cirurgia, facoemulsificação, córneaAbstract
A facectomia com facoemulsificação é uma das cirurgias mais realizadas no mundo. As injeções retrobulbares e peribulbares vêm sendo substituídas pelos anestésicos tópicos, mas os pacientes podem sentir desconforto durante a cirurgia. A anestesia intracameral fornece efeito anestésico adicional. Alguns anestésicos e seus conservantes podem acarretar danos ao endotélio da córnea, dependendo da concentração e do tempo de exposição. Objetiva-se avaliar a segurança e a eficácia de anestésicos na câmara anterior durante a cirurgia de facectomia. Para tanto, procede-se uma revisão na literatura científica, utilizando o banco de dados PubMed/Medline. Encontrou-se que a lidocaína 1% intracameral não causou danos ao endotélio da córnea, mas em concentrações mais altas ou exposição prolongada, pode causar citotoxicidade. A bupivacaína e a proparacaína apresentaram maior toxicidade à córnea, apenas a ropivacaína apresentou superioridade em relação à segurança comparada à lidocaína. O cloreto de benzalcônio é altamente tóxico para córnea e não dever ser injetado na câmara anterior, já o metilparabeno não levou a alterações significativas para córnea. Conclui-se que a lidocaína é segura para uso intracameral, a bupivacaína e proparacaína mostraram toxicidade para a córnea e apenas a ropivacaína mostra superioridade comparada à lidocaína. Conservantes devem ser evitados devido à sua potencial toxicidade para o endotélio da córnea.
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