Impact Of Lidocaine-Induced Mydriasis On Postoperative Outcomes In Deep Sclerectomy: A Case Report.

Highlight a potential complication associated with the use of lidocaine as a topical anesthetic in patient post non-penetrating deep sclerectomy. 

King Khaled Eye Specialist Hospital (KKESH) in Riyadh, Saudi Arabia. 

A 60-year-old woman with advanced normal tension glaucoma (NTG) was referred to the glaucoma division at King Khaled Eye Specialist Hospital (KKESH) in March 2022. Her medical history included controlled type 2 diabetes mellitus, and she had no prior ophthalmic surgeries. Despite adherence to multiple anti-glaucoma drops (timolol 0.5%, prostaglandin analog 0.01%, and brimonidine 0.2%), her glaucoma remained poorly controlled. Initial examination revealed visual acuity of 20/30 OD and 20/25 OS, IOP of 18 mmHg OD and 19 mmHg OS, advanced cupping (C/D ratios of 0.9 OD and 0.8 OS), and significant retinal nerve fiber layer thinning on OCT. Humphrey visual field showed central and deep nasal scotomas OD and a temporal wedge OS. Both eyes had hazel irises, high corneal thickness (580 μm), and wide-open angles on gonioscopy.

Deep sclerectomy was performed successfully on the right eye, followed by the left eye. On the first postoperative day for the left eye, IOP was 16 mmHg with a formed bleb and deep anterior chamber. On the second day, IOP was 18 mmHg with similar findings, but four hours later, the patient experienced severe pain with IOP rising to 46 mmHg and a mid-dilated pupil. Pilocarpine treatment reduced IOP to 19 mmHg. Two weeks later, IOP was 28 mmHg, with a low bleb, closed superior angle, and round undilated pupil. Revision surgery, converted to trabeculectomy, was successful, stabilizing her condition.

In conclusion, our case report highlights the need for caution when using lidocaine as a topical anesthetic in deep sclerectomy. This finding calls for a reevaluation of anesthetic choices in glaucoma surgery to enhance surgical outcomes and improve patient care.