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Role of hyaluronidase as an adjuvant in local anesthesia for cataract surgery

Cataract surgery ranks among the commonest procedures performed worldwide. Approximately 51% of blindness worldwide is related to cataracts, affecting about 65.2 million people worldwide and more so in developing countries. Over the years, there has been a significant evolution in the surgical techn...

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Autores principales: Mohankumar, Arthi, Rajan, Mohan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer - Medknow 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10491076/
https://www.ncbi.nlm.nih.gov/pubmed/37417102
http://dx.doi.org/10.4103/IJO.IJO_2515_22
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author Mohankumar, Arthi
Rajan, Mohan
author_facet Mohankumar, Arthi
Rajan, Mohan
author_sort Mohankumar, Arthi
collection PubMed
description Cataract surgery ranks among the commonest procedures performed worldwide. Approximately 51% of blindness worldwide is related to cataracts, affecting about 65.2 million people worldwide and more so in developing countries. Over the years, there has been a significant evolution in the surgical techniques of cataract extraction. The advancement in phacoemulsification machines, phaco-tips, and the availability of ophthalmic viscoelastic devices have played a substantial role in cataract surgery such that they are faster and more controlled than before. Similarly, anesthetic techniques in cataract surgery have advanced significantly from retrobulbar, peribulbar, and sub-Tenon’s blocks to topical anesthesia. Though topical anesthesia eliminates the possible complications of injectable anesthesia, it is not suitable for use in uncooperative, anxious patients, pediatric age groups, and patients with cognitive disabilities. Hyaluronidase is an enzyme that breaks down hyaluronic acid in the retrobulbar tissue, facilitating uniform diffusion of the anesthetic drug and hastening the onset of anesthesia and akinesia. Hyaluronidase has been used in the last 80 years successfully as an adjuvant in retrobulbar, peribulbar, and sub-Tenon’s blocks. Initially, the hyaluronidase enzyme was animal-derived and of bovine and ovine sources. Recombinant human-derived hyaluronidase, which has lesser allergic reactions, impurities, and toxicity, is now available. There is conflicting evidence regarding the efficacy of hyaluronidase as an adjuvant in retrobulbar and peribulbar blocks. This article summarizes a brief review of the literature on the role of hyaluronidase as an adjuvant in local anesthetic blocks in ophthalmic surgeries.
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spelling pubmed-104910762023-09-09 Role of hyaluronidase as an adjuvant in local anesthesia for cataract surgery Mohankumar, Arthi Rajan, Mohan Indian J Ophthalmol Review Article Cataract surgery ranks among the commonest procedures performed worldwide. Approximately 51% of blindness worldwide is related to cataracts, affecting about 65.2 million people worldwide and more so in developing countries. Over the years, there has been a significant evolution in the surgical techniques of cataract extraction. The advancement in phacoemulsification machines, phaco-tips, and the availability of ophthalmic viscoelastic devices have played a substantial role in cataract surgery such that they are faster and more controlled than before. Similarly, anesthetic techniques in cataract surgery have advanced significantly from retrobulbar, peribulbar, and sub-Tenon’s blocks to topical anesthesia. Though topical anesthesia eliminates the possible complications of injectable anesthesia, it is not suitable for use in uncooperative, anxious patients, pediatric age groups, and patients with cognitive disabilities. Hyaluronidase is an enzyme that breaks down hyaluronic acid in the retrobulbar tissue, facilitating uniform diffusion of the anesthetic drug and hastening the onset of anesthesia and akinesia. Hyaluronidase has been used in the last 80 years successfully as an adjuvant in retrobulbar, peribulbar, and sub-Tenon’s blocks. Initially, the hyaluronidase enzyme was animal-derived and of bovine and ovine sources. Recombinant human-derived hyaluronidase, which has lesser allergic reactions, impurities, and toxicity, is now available. There is conflicting evidence regarding the efficacy of hyaluronidase as an adjuvant in retrobulbar and peribulbar blocks. This article summarizes a brief review of the literature on the role of hyaluronidase as an adjuvant in local anesthetic blocks in ophthalmic surgeries. Wolters Kluwer - Medknow 2023-07 2023-07-05 /pmc/articles/PMC10491076/ /pubmed/37417102 http://dx.doi.org/10.4103/IJO.IJO_2515_22 Text en Copyright: © 2023 Indian Journal of Ophthalmology https://creativecommons.org/licenses/by-nc-sa/4.0/This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Review Article
Mohankumar, Arthi
Rajan, Mohan
Role of hyaluronidase as an adjuvant in local anesthesia for cataract surgery
title Role of hyaluronidase as an adjuvant in local anesthesia for cataract surgery
title_full Role of hyaluronidase as an adjuvant in local anesthesia for cataract surgery
title_fullStr Role of hyaluronidase as an adjuvant in local anesthesia for cataract surgery
title_full_unstemmed Role of hyaluronidase as an adjuvant in local anesthesia for cataract surgery
title_short Role of hyaluronidase as an adjuvant in local anesthesia for cataract surgery
title_sort role of hyaluronidase as an adjuvant in local anesthesia for cataract surgery
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10491076/
https://www.ncbi.nlm.nih.gov/pubmed/37417102
http://dx.doi.org/10.4103/IJO.IJO_2515_22
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