Hyaluronidase cut risk of diplopia after peribulbar anesthesia, study shows

Adding hyaluronidase to the anesthetic solution seems to reduce the risk of postoperative diplopia after peribulbar anesthesia injection, a clinical study suggests.

In a single-center observational case series, Sophie Hamada, MD, and colleagues found an apparent protective action of hyaluronidase against peribulbar-anesthesia-related diplopia in patients undergoing cataract surgery.

The study included all patients who were undergoing elective phacoemulsification and IOL implantation under peribulbar anesthesia between February 2001 and January 2003.

Dr. Hamada and colleagues compared the incidence of postoperative diplopia between two periods – February 2001 to January 2002, and February 2002 to January 2003. In the first period, hyaluronidase was used in the anesthesia solution, and in the second period it was not.

The researchers examined all patients on the first and fifth postoperative days, and when diplopia was diagnosed they recorded the characteristics of the patient, peribulbar anesthesia and diplopia.

In all, 7,205 patients were studied. During the first period, 3,582 patients received peribulbar anesthesia with hyaluronidase, and no cases of diplopia were seen. During the second period, 3,623 patients received peribulbar anesthesia without hyaluronidase, and 27 cases of diplopia occurred. The diplopia was persistent in 54% of the cases.

The authors concluded that peribulbar anesthesia-related diplopia was significantly more frequent when hyaluronidase was not added to the anesthesia solution.

The study is published in the May issue of Ophthalmology.