title: Second cluster of strabismus cases after periocular anesthesia without hyaluronidase.
abstract: We describe a second cluster of cases of iatrogenic strabismus that occurred in clinical practices following cataract surgeries that occurred in 2000 when hyaluronidase was once again unavailable for use in periocular anesthetic regimens. Twelve cases of transient or permanent strabismus were referred by 4 anterior segment surgeons who had no previous cases of postcataract strabismus when performing periocular injections with hyaluronidase. The charts of the patients were reviewed retrospectively. Recurrence of an increase in postoperative strabismus when hyaluronidase became unavailable for a second time supports the concept that this enzyme may be more important than previously suspected in preventing damage to the extraocular muscles after periocular anesthetic injections.
authors.affiliation: Department of Ophthalmology and Visual Sciences, Texas Tech University, Lubbock, Texas 79430-7217, USA. eyesmb@ttuhsc.edu
authors.forename: S M
authors.initials: SM
authors.lastname: Brown
authors.forename: D K
authors.initials: DK
authors.lastname: Coats
authors.forename: M L
authors.initials: ML
authors.lastname: Collins
authors.forename: J P
authors.initials: JP
authors.lastname: Underdahl
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local / Q000009:adverse effects*; D019162:Anesthetics, Combined / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000009:adverse effects*; D002045:Bupivacaine / Q000009:adverse effects; D002387:Cataract Extraction; D016000:Cluster Analysis; D005260:Female; D006801:Humans; D006821:Hyaluronoglucosaminidase; D007049:Iatrogenic Disease; D008012:Lidocaine / Q000009:adverse effects; D008297:Male; D009915:Orbit; D012189:Retrospective Studies; D013285:Strabismus / Q000139:chemically induced*
chemical_list: D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D008012:Lidocaine; D006821:Hyaluronoglucosaminidase; D002045:Bupivacaine