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V. Lam, S. Patel, A. Wulc; Hyaluronidase in Eyelid Surgery - Does It Help Outcomes?. Invest. Ophthalmol. Vis. Sci. 2010;51(13):4560.
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Hyaluronidase (HYA), an enzyme that cleaves hyaluronic acid, is used during eye surgery to improve the spread and absorption of local anesthetics. In eyelid surgery, this spread presumably allows any tissue edema or ecchymosis to dissipate and allows a more accurate eyelid repair. Some plastic surgeons inject HYA at the conclusion of surgery to lessen postop swelling1. There are no studies that have investigated the benefits of adding HYA to local anesthesia for eyelid surgery and its effect in reducing postop ecchymosis, edema, erythema, and patient discomfort. We performed a prospective, randomized, double-blinded IRB approved trial, which evaluated the postop effects of using HYA in eyelid surgery.
11 patients seeking surgical treatment for bilateral symmetric ptosis, dermatochalasis, entropion, or ectropion, were recruited. Each patient received local anesthetic with HYA in one eye and local anesthetic only in the other eye (Custom Compounding Center, CA, 25 U/cc). The surgeon, evaluating physician, and patient were blinded as to which eye received HYA. Patients applied antibiotic ointment and cold compresses during the first postop week. Follow-up was done on postop days 1, 7, 14, 30, and 90. On each postop visit, patients were asked to evaluate pain, burning, tingling, redness, swelling, tightness, difficulty moving eye, bruising, rash, and itching. The evaluating physician rated the amount of edema, erythema, and ecchymosis. Photographic documentation was performed at each visit.
The data were significant for decreased ecchymosis (P < 0.0009) and increased edema (P < 0.08) in HYA treated patients (per the evaluating physician). Patient survey results indicated more edema in the HYA eye (P < 0.03).
The overall outcome of each eye was identical in all 11 cases. The data show that HYA does not decrease patient discomfort, erythema or ecchymosis. The data imply that HYA treated patients had a greater amount of postop edema in the first postop week.
1. Stark, RB; Aesthetic Plastic Surgery, Little, Brown, and Company, Boston p. 89 (1978)
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