title: Role of hyaluronidase in diplopia after peribulbar anesthesia for cataract surgery.
abstract: OBJECTIVE
  To determine the protective action of hyaluronidase on peribulbar anesthesia-related diplopia in patients undergoing cataract surgery.
  
  
  METHODS
  Single-center observational case series.
  
  
  METHODS
  All patients undergoing elective phacoemulsification and intraocular lens implantation under peribulbar anesthesia between February 2001 and January 2003.
  
  
  METHODS
  We compared the incidence of postoperative diplopia between 2 periods--February 2001 to January 2002 (P1) and February 2002 to January 2003 (P2)--which differed by the presence (P1) or absence (P2) of hyaluronidase in the anesthetic solution.
  
  
  METHODS
  All patients were examined on the first and fifth postoperative days during both periods. When diplopia was diagnosed, we recorded the characteristics of the patient, peribulbar anesthesia, and diplopia (orthoptic examination, and magnetic resonance imaging in some cases).
  
  
  RESULTS
  Seven thousand two hundred five patients were studied. During P1, 3582 patients received peribulbar anesthesia, and no cases of diplopia occurred. During P2, 3623 patients received peribulbar anesthesia, and 27 cases of diplopia occurred (incidence, 0.75%; P = 0.0002 vs. P1). Diplopia involved the inferior rectus (40%) and the external rectus (37%) muscles. Diplopia was persistent in 54% of the cases.
  
  
  CONCLUSIONS
  Peribulbar anesthesia-related diplopia was significantly more frequent when hyaluronidase was not added to the anesthetic solution.
authors.affiliation: Department of Anesthesiology and Intensive Care, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Hamada
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Devys
authors.forename: Thanh Hoang
authors.initials: TH
authors.lastname: Xuan
authors.forename: Stéphane
authors.initials: S
authors.lastname: Ganem
authors.forename: José-Alain
authors.initials: JA
authors.lastname: Sahel
authors.forename: Françoise
authors.initials: F
authors.lastname: Héran
authors.forename: Benoît
authors.initials: B
authors.lastname: Plaud
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local / Q000379:methods*; D019162:Anesthetics, Combined / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage; D004172:Diplopia / Q000503:physiopathology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D006821:Hyaluronoglucosaminidase / Q000502:physiology*; D019654:Lens Implantation, Intraocular; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000503:physiopathology; D009915:Orbit; D018918:Phacoemulsification
chemical_list: D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D008012:Lidocaine; D006821:Hyaluronoglucosaminidase; D002045:Bupivacaine