Efficacy of Hyaluronidase in Reducing Increases in Intraocular Pressure Related to the Use of Viscoelastic Substances

Abstract

To evaluate the efficacy of hyaluronidase in preventing increases in intraocular pressure related to injections of hyaluronan-containing viscoelastic substances.Methods: Twenty-five white rabbits were divided into 5 groups. In groups 1 through 4, 0.15 mL of aqueous humor was removed and replaced with 0.10 mL of a viscoelastic substance in both eyes. Additionally, 10 units of hyaluronidase (0.05 mL) was injected in the anterior chamber of the right eye, whereas the left eye was injected with a volumetrically equivalent dose of balanced saline solution. Viscoelastic substances tested were Healon and Healon GV (Pharmacia & Upjohn, Kalamazoo, Mich), Viscoat (Alcon Laboratories, Fort Worth, Tex), and Ocucoat (Storz Ophthalmics, Clearwater, Fla). In group 5, right eyes were injected with 10 units of hyaluronidase and the left eyes were treated with balanced saline solution.Results: After injections of viscoelastic substance, intraocular pressure rose rapidly, reaching a peak at approximately 46 hours after injection and returning to preinjection levels within 24 hours. Hyaluronidase significantly decreased intraocular pressure when used with Healon, Healon GV, and Viscoat, but not with Ocucoat. When injected in the absence of viscoelastic, hyaluronidase appeared to decrease intraocular pressure, but this result was not statistically significant.Conclusions: Injections of hyaluronidase into the anterior chamber of rabbits effectively prevent increases in intraocular pressure induced by hyaluronan-containing viscoelastic substances. This effect may be related to the ability of hyaluronidase to cleave hyaluronan moieties.

Ocular delivery of proteins and peptides: Challenges and novel formulation approaches

“…However, the high viscosity of HA allows it to act as a molecular sieve, thus preventing the penetration of most biopharmaceutical formulations. The property of hyaluronidase (Hyal) to catalyze the degradation of HA have been exploited for decades to increase the penetration of biopharmaceutical drugs across ocular tissue barriers [77, 78]. …”

Patching retinal breaks with Seprafilm for treating retinal detachments in humans: 9 years of follow-up

“…Although the exact mechanisms by which Seprafilm causes transient ocular hypertension are unclear, increased resistance to the flow of aqueous humor may occur in the trabecular meshwork as reported for ocular hypertension related to viscoelastic substances. 11 We detected visual field defects either in the inferonasal or inferotemporal quadrant that did not correspond to the area of the RRDs. The visual field defects were more prominent in the first two operated eyes, in which it took longer to deliver the Seprafilm after fluid-air exchange.…”

Effect of Chondroitin Sulfate on Intraocular Pressure in Rats

“…Given that viscoelastic agents containing HA but lacking CS, such as sodium hyaluronate (Healon [1% HA], Healon 5 [2.3% HA], and Healon GV [1.4% HA]; Abbott Medical Optics, Santa Ana, CA), also increase IOP in humans, the hypertensive effect of viscoelastic solution (Viscoat 3.0% HA-4.0% CS; Alcon Laboratories) could be attributed primarily to HA. The hypertensive effect of HA injections in the eye anterior chamber was demonstrated in several species, such as rabbit 43 and rat. 39 To our knowledge, the effect of CS on rat IOP was not previously examined.…”