[Hyaluronidase: Here we go again].
OBJECTIVE
To summarize the benefits and lateral effects of hyaluronidase (H) use in ophthalmologic anaesthesia and to address its unavailability in current practice in France.


METHODS
The Medline data bank and the Cochrane database were consulted. The keywords employed separately or in combination were: H, regional anaesthesia, ophthalmologic surgery, local aneasthetics myotoxicity, diplopia.


METHODS
Original articles since 1949 were selected. We also selected isolated clinical cases according to their relevance compared with the existing literature.


RESULTS
H is a "spreading factor" of animal origin used as an adjuvant in ophthalmic anaesthesia for more than half a century. It allows a moderate better block quality with a slightly quicker onset. It also limits the acute intraocular pressure increase secondary to periocular injection and seems to have a protective effect against local anaesthetics myotoxicity resulting in postoperative strabismus. However, during these last 50 years, numerous studies often ended in divergent results.


CONCLUSIONS
H seems to be a useful adjuvant in ophthalmologic anaesthesia in spite of his current unavailability in France. Recombinant H could be the solution in the near future.
Etesse
B
B
Pôle Anesthésie-Douleur-urgences-Réanimation, Groupe Hospitalo-Universitaire Carémeau, 30029 Nîmes cedex 09, France.
Beaudroit
L
L
Deleuze
M
M
Nouvellon
E
E
Ripart
J
J
D000759:Adjuvants, Anesthesia; D000765:Anesthesia, Conduction; D004172:Diplopia / Q000601:surgery; D005602:France; D006801:Humans; D006821:Hyaluronoglucosaminidase / Q000008:administration & dosage / Q000627:therapeutic use*; D007267:Injections; D007429:Intraocular Pressure / Q000187:drug effects; D013508:Ophthalmologic Surgical Procedures; D009886:Ophthalmoplegia / Q000139:chemically induced / Q000517:prevention & control; D011183:Postoperative Complications / Q000517:prevention & control; D020011:Protective Agents / Q000627:therapeutic use; D013285:Strabismus / Q000209:etiology / Q000517:prevention & control
D000759:Adjuvants, Anesthesia; D020011:Protective Agents; D006821:Hyaluronoglucosaminidase