AAO 2024: Chloroprocaine ophthalmic gel as anesthesia for intravitreal injections

Michael Singer, MD, shared insights from on his experience using a preservative-free, chloroprocaine ophthalmic gel as anesthesia for intravitreal injections and the results of research on the effectiveness of gel versus traditional drops.

This transcript has been lightly edited for clarity.

Michael Singer, MD: Hi, my name is Michael Singer. I'm thrilled today to talk about IHEEZO. Basically what it is, it's a topical anesthetic. It's a viscous anesthetic, and initially it was approved for the use in cataract surgery, but recently its transition for the use is prep for patients who want anesthesia in intravitreal injections, and I've been incorporating it into my practice over the last 5 to 6 months and had very good success.

What I think is interesting to understand on this gel, because when I talk to a lot of my colleagues, they're all worried about gels have a fairly bad reputation, because they say there's an increase in endophthalmitis versus topical liquid juice for anesthesia. Well, it turns out recently, there was a study that looked at the use of betadine in conjunction with the gel, as opposed to using it in conjunction with tetracaine drops. And what it showed was that more colonies were removed using betadine with the gel than with the drops, basically explaining that this is even safer than tetracaine drops. So what I love about the concept is we're dispelling a myth. We're able to give better anesthesia for our patients and actually inject them more efficiently to make the whole experience for both them and for us, more beneficial. I mean, in my experience, it has basically been at least as quick, if not quicker, than typical tetracaine-based gels.

It was shown during the cataract surgery process that essentially within 90 seconds you're able to get anesthesia, and they ran a number of studies that showed, over time, at 3 different time points that that you, with 3 installations, 90 seconds later, you were able to do cataract surgery without needing any supplemental anesthesia, which was really important because the tetracaine dropped arm needed supplemental anesthesia while the IHEEZO did not Well, obviously I made reference to this earlier. The thing that basically keeps us up at night is endophthalmitis. And the story is that, the fallacy or wasn't a fallacy, it was at least a myth that patients who had gels were more likely to end up with endophthalmitis after intravitreal injections and cataract surgeries than patients who had drops. The study there, where we showed that there were less colony forming bacteria with the use of IHEEZO in conjunction with betadine, as opposed to IHEEZO in conjunction with tetracaine drops. Adds a lot of credibility to the fact that this is a good, safe alternative to our patients undergoing intraocular procedures, whether it be a cataract or intravitreal injections.

Well, one of the things that patients have problems with is they maybe have sensitivity to summon a preservative things, things like the AK and other things of that nature. Having a preservative-free formulation is one less thing we have to worry about so our patients don't have postoperative pain, and they have a suboptimal postoperative experience, and our staff is called the hours in the evening and on weekends because they don't feel it. It's one less thing to worry about, just like we do with our drops.