Corneal endothelial changes after intracameral lidocaine injection: A literature review

Abstract

Cataract surgery is one of the most frequently performed ophthalmic procedures worldwide. Along with advances in surgical techniques, the use of local anesthesia particularly intracameral lidocaine has gained widespread acceptance due to its rapid onset, simplicity, and effective intraoperative pain control. Nevertheless, concerns remain regarding the potential toxic effects of intracameral lidocaine on corneal endothelial cells, which play a crucial role in maintaining corneal transparency. This review aims to summarize and critically evaluate current evidence on morphological and functional changes of corneal endothelial cells following intracameral lidocaine administration. A structured literature search was conducted using PubMed, ScienceDirect, and Google Scholar databases, employing the keywords “corneal endothelial changes,” “intracameral lidocaine injection,” and “intracameral injection toxicity.” Articles published within the last 10 years were considered, including randomized controlled trials, cohort studies, and experimental investigations focusing on endothelial outcomes after lidocaine exposure. From 652 initially identified articles, 12 studies met the inclusion criteria. The reviewed evidence indicates that high concentrations of lidocaine (>2%) and prolonged exposure may induce endothelial cell apoptosis via oxidative stress and mitochondrial dysfunction, potentially resulting in corneal edema and endothelial cell loss. In contrast, intracameral lidocaine at a concentration of 1%, particularly when combined with agents such as tropicamide and phenylephrine (Mydrane®), appears to be safe and associated with minimal endothelial alterations. Experimental data also suggest that antioxidant agents may mitigate lidocaine-induced oxidative damage. In conclusion, intracameral lidocaine remains an effective and generally safe anesthetic option for cataract surgery when appropriate concentrations and exposure times are used, with special consideration given to patients with compromised endothelial reserve.

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