Efficacy of Mid-Procedure Lidocaine in Reducing Pain from Intracameral Moxifloxacin Injection During Cataract Surgery

Purpose Intracameral moxifloxacin administered at the conclusion of cataract surgery reduces postoperative drop burden and infection risk but may cause injection-related discomfort, potentially affecting patient safety and satisfaction. This study evaluated whether an additional mid-procedure dose of intracameral lidocaine could reduce pain associated with moxifloxacin injection. Methods This prospective interventional study included 50 cataract surgery patients under monitored anesthesia care. The interventional group (n=25) received an additional intracameral dose of 1% preservative-free lidocaine during instrument exchange, while the control group (n=25) did not. All patients then received intracameral moxifloxacin at the end of surgery, reporting verbal 0-10 pain scores before and after injection. Pain-delta scores, representing pain responses to moxifloxacin, were compared between the two groups. Patient age, sex, midazolam dosage administered prior to surgery, pre-operative spherical equivalent, and total operative time, were evaluated as potential confounders or effect modifiers. Results Mean pain-delta scores were significantly lower in the interventional group compared with controls (0.46 vs 2.22), representing a 1.76-point or 79% reduction in pain (p=0.003). On multiple linear regression, mid-procedure lidocaine remained independently associated with a 1.67-point reduction in pain-delta scores (95% CI: −2.83 to −0.50; p=0.006) after adjustment for demographic and perioperative factors. Conclusions A mid-procedure dose of lidocaine significantly reduces pain with intracameral moxifloxacin injection, independent of patient and perioperative variables. This simple, convenient, and low-cost intervention improves patient comfort and facilitates broader adoption of intracameral antibiotic prophylaxis during cataract surgery.