Does the addition of hyaluronidase improve the quality of peribulbar anesthesia in cataract surgery? – A randomized double blinded study

Nagarajan, Swathi; Srikanth, Krishnamoorthy; Venipriya, S.

doi:10.1016/j.sjopt.2018.02.013

Cited by 8 publications

(13 citation statements)

References 28 publications

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“…In this study, all the cases were performed under peribulbaranesthesia, which is the primary technique for achieving ocular akinesia across the Indian subcontinent. [ 33 ] However, we believe this method has a high risk of complications, such as globe perforation, as it requires blind instrumentation. [ 34 ] Hence currently, we perform the majority of phacoemulsifications under topical anesthesia, and if required an akinesia sub-tenon block is adopted.…”

Section: Discussionmentioning

confidence: 99%

Phacoemulsification vs manual small incision cataract surgery in eyes affected by pseudo exfoliation syndrome with grade II and III cataracts

et al. 2020

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PURPOSE: To compare the postoperative alteration of central corneal thickness (CCT) and visual outcomes between phacoemulsification (group A) and manual small incision cataract surgery (MSICS) (group B) in grade II and III nuclear cataracts (NS II and III) with pseudoexfoliation syndrome (PXF). METHODS: It is a double masked prospective randomised interventional study. A total of 60 eyes of 60 patients were assigned randomly to either the phacoemulsification (group A) or MSICS (group B) groups. All eyes had nuclear sclerosis grade II and III (LOCS II grading system) with pseudoexfoliation material either over the pupillary margin, anterior lens capsule, or both. All surgeries were done by a single surgeon. Postoperative evaluation was scheduled on the 1st, 30th, 90th, and 180th-day. Statistical analyses were done using appropriate methods. Outcome of the study were measured with changes in central corneal thickness (CCT), Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA) and the spherical equivalent in the operated eye up to 6 months post surgery. RESULTS: The mean preoperative CCT showed no difference between the groups (0.9659). The mean rise in CCT on the 1st postoperative day (POD) showed a significant difference between the groups {24.65 (SD 9.32) [group A (Phacoemulsification)] and 33.34 (SD11.68) [group B (MSICS)] ( P < 0.0023)}. At the 1st, 3rd, and 6th month postoperative visits, there was no significant difference. The mean uncorrected distance visual acuity (UDVA) on the 1st POD was 0.189 (SD 0.118) in Group A and 0.302 (SD 0.121) in group B ( P < 0.0005) which was significantly better with the phacoemulsification procedure. At the 1st month it was 0.039 (SD 0.084) in group A and 0.148 (SD 0.089) in group B ( P < 0.004), which remained almost stable after that. The mean corrected distance visual acuity (CDVA) at the 1st, 3rd, and 6th-month postoperative visits showed no significant difference (P 0.8). The mean spherical equivalent was 0.29 in group A and 0.8 in group B. CONCLUSION: In moderately hard nuclear cataracts with PXF, phacoemulsification provides better unaided visual outcomes with less endothelial dysfunction than MSICS in the immediate and subsequent postoperative period.

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Section: Discussionmentioning

confidence: 99%

Phacoemulsification vs manual small incision cataract surgery in eyes affected by pseudo exfoliation syndrome with grade II and III cataracts

et al. 2020

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“…[4][5][6] Although several trials have suggested beneficial effects of RAI with hyaluronidase, including more rapid block onset, better akinesia, and better analgesia, others failed to show convincing differences in clinical efficacy. 2,[7][8][9][10][11][12] Despite its disputed clinical efficacy, hyaluronidase use is very common and several clinical preparations are commercially available. Adding hyaluronidase to RAI solutions reduces the effective concentration of the anesthetic; increases the complexity of mixing the anesthetic cocktail, introducing the possibility of a compounding error; increases cost; and may require a licensed compounding pharmacy for regulatory compliance.…”

Section: Introductionmentioning

confidence: 99%

“…4–6 Although several trials have suggested beneficial effects of RAI with hyaluronidase, including more rapid block onset, better akinesia, and better analgesia, others failed to show convincing differences in clinical efficacy. 2,7–12…”

Section: Introductionmentioning

confidence: 99%

Orbital Dynamics and Efficacy of Retrobulbar Anesthesia With and Without Hyaluronidase in Vitreoretinal Surgery

Harris

Riemann

Burk

et al. 2023

Journal of VitreoRetinal Diseases

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Purpose: To compare retrobulbar anesthesia injection (RAI) with hyaluronidase and without hyaluronidase in vitreoretinal surgery using clinical efficacy measures and orbital manometry (OM). Methods: This prospective randomized double-masked study enrolled patients who had surgery using an 8 mL RAI with or without hyaluronidase. Outcome measures were clinical block effectiveness (akinesia, pain scores, need for supplemental anesthetic or sedative medications) and orbital dynamics assessed by OM before and up to 5 minutes after RAI. Results: Twenty-two patients received RAI with hyaluronidase (Group H+), and 25 received RAI without hyaluronidase (Group H−). Baseline characteristics were well matched. No differences in clinical efficacy were found. OM showed no difference in preinjection orbital tension (4 ± 2 mm Hg in both groups) or calculated orbital compliance (0.6 ± 0.3 mL/mm Hg, Group H+; 0.5 ± 0.2 mL/mm Hg, Group H−) ( P = .13). After RAI, the peak orbital tension was 23 ± 15 mm Hg in Group H+ and 24 ± 9 mm Hg in Group H− ( P = .67); it declined more rapidly in Group H+. Orbital tension at 5 minutes was 6 ± 3 mm Hg in Group H+ and 11 ± 5 mm Hg in Group H− ( P = .0008). Conclusions: OM showed faster resolution of post-RAI orbital tension elevation with hyaluronidase; however, there were no clinically evident differences between groups. Thus, 8 mL RAI with or without hyaluronidase is safe and can achieve excellent clinical results. Our data do not support the routine use of hyaluronidase with RAI.

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“…Ibrahim et al [1] did not use midazolam in systemic form. Hyaluronidase was also tested by Swati et al [2] in a randomized double-blind study but did not prove to be beneficial in any sense. Rocuronium, a neuromuscular blocking agent, was also tried by Patil et al [3] and found to have a beneficial effect on the onset of akinesia but no effect on anesthesia.…”

mentioning

confidence: 99%

“…All these studies[1234] have been done in cataract surgery, which generally gets over in few minutes. Other ocular surgeries that take more time are vitreo-retinal surgery, keratoplasty, oculoplasty, etc., Early onset, prolonged duration of PA, and non-requirement of a supplementary block will be very useful in such surgeries.…”

mentioning

confidence: 99%

Commentary: Adjunctive agents in peribulbar anesthesia: Role of dexmedetomidine in vitreo-retinal surgeries

Bhandari

2019

Indian J Ophthalmol

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Does the addition of hyaluronidase improve the quality of peribulbar anesthesia in cataract surgery? – A randomized double blinded study

Abstract: Hyaluronidase is not an essential adjuvant for peribulbar block for cataract surgeries. Appropriate deposition of a smaller volume of anesthetic agent and adequate ocular massage provide adequate and safe anesthesia.

Cited by 8 publications

References 28 publications

Phacoemulsification vs manual small incision cataract surgery in eyes affected by pseudo exfoliation syndrome with grade II and III cataracts

Phacoemulsification vs manual small incision cataract surgery in eyes affected by pseudo exfoliation syndrome with grade II and III cataracts

Orbital Dynamics and Efficacy of Retrobulbar Anesthesia With and Without Hyaluronidase in Vitreoretinal Surgery

Commentary: Adjunctive agents in peribulbar anesthesia: Role of dexmedetomidine in vitreo-retinal surgeries

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