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

PURPOSE: To determine the necessity of hyaluronidase as an anesthetic adjuvant for peribulbar anesthesia during cataract surgery and to assess differences in anesthetic outcomes in the absence of hyaluronidase. METHODS: In this double blinded randomized study, 202 patients reporting for surgery for senile cataract in their first eye under regional ocular anesthesia without pre-existing extra ocular movement restriction were randomly divided into 2 groups: Group 1 - anesthesia without hyaluronidase, Group 2 - anesthesia with 50 IU/ml Hyaluronidase. Peribulbar block with 5 ml of anesthetic mixture of 2% lignocaine with 1:200000 adrenaline and 0.5% bupivacaine with or without hyaluronidase was performed with 3 ml deposited in the infero-medial quadrant and 2 ml in the supero-medial quadrant followed by ocular massage. Surgeons' score for akinesia, patients' score for analgesia, augmentation of block if any and extra ocular movements on first post-operative day were compared between the groups. RESULTS: There was no statistically significant difference between the two groups in akinesia (p = 0.22, 0.68 and 0.98), analgesia (p = 0.44 and 0.09) or requirement of anesthetic augmentation (p = 0.3). Extraocular movement restriction was not noted in any patient. Onset of akinesia and analgesia was earlier in Group 2 (p = 0.004 and p = 0.005 respectively). CONCLUSIONS: 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.

An undetected intraorbital foreign body after a "trivial" facial injury.

Intraorbital foreign objects are common after high-velocity injuries and can result in disastrous consequences. A "trivial" facial injury may sometimes obscure the presence of an intraorbital foreign object. Difficulties in the approach to the intraconal space and possible surgical morbidity to the optic nerve make management especially challenging. We are reporting a case wherein an intraconal foreign body was missed during the initial examination of a maxillofacial injury and was subsequently successfully extracted by an endoscopic approach.