For nearly all of my cataract surgery cases, I prefer topical anesthesia which is then augmented with mild intra-venous sedation and intra-cameral agents. For the topical anesthesia we have traditionally relied on tetracaine solution for cataract surgery and proparacaine solution for LASIK / PRK surgery. These agents work well but they have limitations particularly in terms on contact time with the ocular surface. Using a topical anesthetic with a gel formulation can keep the anesthetic agent on the ocular surface longer and also prevent corneal dryness due to lack of blinking from the effect of anesthesia. Recently I have been using preservative-free chloroprocaine HCl 3% gel (trade name Iheezo from Harrow) which gives potent ocular surface anesthesia in just 3 drops. I instill one drop in the pre-op area and then two more drops once the patient is in the operating room and before the start of surgery. Onset of action is about 40 seconds and the duration of effect is about 15 to 20 minutes. The level of ocular surface anesthesia is so good that I can perform conjunctival and scleral incisions (including electro-cautery and suturing) without additional local anesthetics.
Note that this is an independent video from Dr Devgan. The CataractCoach PodCast is sponsored by Harrow, Inc.
It’s quite expensive……582 dollars per serving. There is that to consider.
I’ve used this several times and it works well. However it costs $500 and not covered by all insurances. Concerned about potential cost to surgical center and patient. Regular lidocaine is pennies and works well.
The cost is close to $600 for a single use vial, which is more than what Medicare pays for the surgical fee for the surgery and 90 days of postop care. And I think although Medicare is allowing it as a pass-through medication for the next few years, I am not sure the cost is justified for something with nearly equivalent substitutes that cost just a few cents.
Sir ,
I am veterinary ophthalmologist from India. Very good post ! Thanks
A small query – while the gel based combinations increase the residence time of the active ingredient , do we have to wash the gel off from the ocular surface after 3 times application , prior to corneal incision , to prevent gel particles entering the chamber? ,like ointments are with held prior to intra ocular procedures.
It has a j code and is reimbursed so the cost is nothing to the patient. The doctor is also paid a fee above product cost. Has no impact to overall cost