Effect of hyaluronidase on ocular motility in sub-Tenon’s anesthesia: randomized controlled trial

Abstract

Purpose To assess the effect of hyaluronidase additive on the onset and degree of ocular akinesia in sub-Tenon’s anesthesia for cataract surgery. Setting Routine cataract operating list. Method This double-blind randomized controlled study comprised 100 patients who had phacoemulsification cataract surgery. Patients were randomized to 1 of 2 groups. For sub-Tenon’s anesthesia, Group A received 5 mL lignocaine 2% with sodium hyaluronidase 150 IU/mL and Group B, 5 mL plain lignocaine 2%. Akinesia was assessed by scoring movement in the 6 positions of gaze. Scores ranged from 0 (complete akinesia) to 3 (no akinesia). Movements were measured at 30 seconds and 1, 3, 5, and 10 minutes. Changes in motility scores were compared by the Mann-Whitney U test. Results There was no significant difference in akinesia between the 2 groups 30 seconds after the injection ( P = .224); however, at 1 and 3 minutes, Group A achieved significantly better akinesia than Group B ( P = .003 and P = .023, respectively). The median score after 3 minutes was 3.5 (interquartile range 0 to 7.5) in Group A and 7.0 (interquartile range 2.5 to 10.0) in Group B. There was no significant difference between the groups at 5 and 10 minutes ( P = .225 and P = .831, respectively). Conclusions The addition of hyaluronidase in sub-Tenon’s anesthesia significantly improved the rapidity of the onset of akinesia. This benefit disappeared over time; after 5 minutes the akinesia observed in the group receiving hyaluronidase was similar to that in the group receiving lignocaine alone. Thus, there appears to be no benefit to adding hyaluronidase to the anesthetic solution in terms of final ocular akinesia.