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Ang T, Chaggar V, Tong JY, Selva D. Medication-associated orbital inflammation: A systematic review. Surv Ophthalmol 2024:S0039-6257(24)00020-1. [PMID: 38490453 DOI: 10.1016/j.survophthal.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 02/28/2024] [Accepted: 03/11/2024] [Indexed: 03/17/2024]
Abstract
We performed a comprehensive systematic review to identify medication-associated orbital inflammation and to characterize its clinico-radiological features. We reviewed English-language articles describing medication-associated orbital inflammation (i.e., orbital myositis, dacryoadenitis and orbital fat) published to June, 2023. Isolated inflammation of the intraocular structures or globe alone (i.e. uveitis, scleritis, optic neuritis and perineuritis) were excluded. In medication-associated orbital inflammation, the extraocular muscles are preferentially affected, occurring in isolation or in combination with other orbital and/or intraocular structures. Clinico-radiological manifestations may be non-specific; however, certain medications may be distinguished according to the presence of systemic prodrome, laterality, associated intraocular inflammation, and predisposition to involve certain orbital structures. Rapid identification, discontinuation of the provoking medication, and systemic corticosteroid therapy (if appropriate) typically achieves a favorable visual prognosis. As new medications become adopted by clinicians, rare adverse effects will be further delineated.Medication-associated orbital inflammation is an important diagnostic consideration in orbital inflammatory disease. A careful medication history and clinical assessment may be revealing, permitting timely discontinuation of the offending agent and initiation of appropriate management.
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Affiliation(s)
- Terence Ang
- The University of Adelaide, Adelaide, South Australia, Australia.
| | - Viraj Chaggar
- The University of Adelaide, Adelaide, South Australia, Australia
| | - Jessica Y Tong
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Dinesh Selva
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Guliyeva G, Huayllani MT, Kraft C, Lehrman C, Kraft MT. Allergic Complications of Hyaluronidase Injection: Risk Factors, Treatment Strategies, and Recommendations for Management. Aesthetic Plast Surg 2024; 48:413-439. [PMID: 37145319 DOI: 10.1007/s00266-023-03348-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 03/27/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Hyaluronidase is used as a reversal agent for hyaluronic acid fillers and to increase the diffusion of other medications after infiltration. Cases of hyaluronidase allergy have been described in the literature since 1984. However, it is still frequently misdiagnosed. This review aims to summarize the current literature to describe the clinical picture of hyaluronidase allergy and identify any risk factors associated with its development, as well as provide recommendations for management in plastic surgery. METHODS A digital search of PubMed, Scopus, and Embase databases was performed by two reviewers following the PRISMA guidelines. This search identified 247 articles. RESULTS Two hundred forty-seven articles were identified, and 37 of them met the eligibility criteria. One hundred six patients with a mean age of 54.2 years were included in these studies. History of allergy to other substances (timothy grass, egg white, horse serum, penicillin, insect bites, wasp venom, thimerosal, potassium, histamine, phenylmercuric acetate, and nickel) and allergic diseases (asthma, dermatitis, atopy, rhinitis) was reported. A large portion of the patients with a history of repeated exposure (2-4) experienced the symptoms with their second injection. Nonetheless, there was no significant association between time to allergy development and the number of exposures (P = 0.3). Treatment with steroids +/- antihistamines resulted in the rapid and predominantly complete reversal of the symptoms. CONCLUSIONS Prior injections or sensitization by insect/wasp venom might be the primary factor associated with hyaluronidase allergy development. The time between the repeated injections is not a likely contributor to the presentation. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Gunel Guliyeva
- Department of Plastic and Reconstructive Surgery, The Ohio State University, Columbus, OH, USA
| | - Maria T Huayllani
- Department of Plastic and Reconstructive Surgery, The Ohio State University, Columbus, OH, USA
| | - Casey Kraft
- "Cosmetic and Plastic Surgery of Columbus, Inc", at 41 Commerce Parkway, Westerville, OH, USA
| | - Craig Lehrman
- Department of Plastic and Reconstructive Surgery, The Ohio State University, Columbus, OH, USA
| | - Monica T Kraft
- Division of Allergy and Immunology, Department of Otolaryngology, The Ohio State University, 915 Olentangy River Rd, Columbus, OH, 43212, USA.
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3
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Gupta A, Moharana B, Saini R, Gupta A. Pretreatment with systemic corticosteroid can mask early symptoms of hypersensitivity reaction to hyaluronidase following peribulbar block. BMJ Case Rep 2022; 15:e247208. [PMID: 35246434 PMCID: PMC8900017 DOI: 10.1136/bcr-2021-247208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2022] [Indexed: 11/03/2022] Open
Abstract
Hyaluronidase is a hydrolytic enzyme that helps in breaking down hyaluronic acid, a component of the extracellular tissue matrix, thereby facilitating the dispersion of local anaesthetic drugs through tissue planes. It is a key component in peribulbar anaesthesia for ocular surgeries. Allergic response to hyaluronidase is relatively rare but a potentially vision-threatening complication. A preoperative intradermal hypersensitivity test is useful to detect such cases and avoid potential complications. Here we report a case of hypersensitivity reaction to hyaluronidase after peribulbar anaesthesia for cataract surgery where an intradermal hypersensitivity test was falsely negative, and presentation was delayed due to the use of preoperative systemic corticosteroids. However, correct, and timely diagnosis and treatment saved the eye from permanent vision loss.
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Affiliation(s)
- Ashok Gupta
- Department of Ophthalmology, Drishti Eye Hospital, Panchkula, Haryana, India
| | - Bruttendu Moharana
- Department of Ophthalmology, All India Institute of Medical Science - Bhopal, Bhopal, Madhya Pradesh, India
| | - Reeti Saini
- Department of Ophthalmology, Drishti Eye Hospital, Panchkula, Haryana, India
| | - Arjun Gupta
- Department of Ophthalmology, Drishti Eye Hospital, Panchkula, Haryana, India
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4
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Schargus M, Schargus V, Rath S. [Forms of anesthesia in ophthalmology]. Ophthalmologe 2021; 118:413-428. [PMID: 33651138 DOI: 10.1007/s00347-021-01334-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2021] [Indexed: 12/01/2022]
Abstract
The range of anesthesiological procedures in ophthalmology has not changed significantly over the last decades, with local anesthesia clearly coming to the fore. The development of minimally invasive surgical techniques requires significantly less analgesia and economic constraints to shorten operating times. The increasing proportion of outpatient ophthalmic surgery requires a short analgesia of the surgical area with as few complications as possible. Nevertheless, the selection of the procedures, which are described here in detail, must be made individually for each patient. General anesthesia continues to have its place, especially in cases of reduced compliance and difficult surgical conditions. The close cooperation between anesthetists and ophthalmic surgeons, e.g. for analgosedation in the outpatient area, can create a very pleasant surgical experience for the patient. An important goal should always be sufficient anxiolysis, analgesia and, in special operations, sufficient akinesia.
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Affiliation(s)
- Marc Schargus
- Asklepios Augenklinik Nord-Heidberg, Tangstedter Landstr. 400, 22417, Hamburg, Deutschland. .,Klinik für Augenheilkunde, Heinrich-Heine-Universität, Düsseldorf, Deutschland.
| | - Veronika Schargus
- Asklepios Augenklinik Nord-Heidberg, Tangstedter Landstr. 400, 22417, Hamburg, Deutschland
| | - Stephan Rath
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universität Köln, Köln, Deutschland
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Deshmukh S, Bhattacharjee H, Gupta K. Potentially blinding adverse drug reaction to peribulbar lignocaine anesthesia: A rare case report. Indian J Pharmacol 2020; 52:138-141. [PMID: 32565602 PMCID: PMC7282685 DOI: 10.4103/ijp.ijp_4_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 05/02/2019] [Accepted: 03/24/2020] [Indexed: 11/17/2022] Open
Abstract
Peribulbar lignocaine anesthesia is commonly used in ophthalmic surgeries. It rarely causes any severe allergic reaction. A 63-year-old male presented with complicated pseudophakia. He underwent successful vitrectomy under local anesthesia. He later presented with acute-onset proptosis, orbital swelling, and extraocular movement restriction. He was afebrile with normal blood workup and radiological investigations and gave a similar past history. The patient was treated successfully with intravenous medications but two months later developed optic atrophy. An adverse reaction to lignocaine appears to be the most probable cause. Early detection and prompt management of this condition may avert a potentially grave visual outcome. Literature review shows that this case is one of its kinds to report this potentially blinding complication of peribulbar lignocaine anesthesia.
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Affiliation(s)
- Saurabh Deshmukh
- Department of Vitreo-Retina Services, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
| | - Harsha Bhattacharjee
- Department of Vitreo-Retina Services, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
| | - Krati Gupta
- Department of Vitreo-Retina Services, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
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Alcubierre R, Sanchez-Dalmau BF, Mousavi K. Compressive optic neuropathy secondary to an allergic reaction to hyaluronidase. ACTA ACUST UNITED AC 2019; 94:441-444. [PMID: 31280939 DOI: 10.1016/j.oftal.2019.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/17/2019] [Accepted: 03/23/2019] [Indexed: 10/26/2022]
Abstract
A 58 year-old woman presented with severe chemosis and ophthalmoparesis on her left eye 8hours after uncomplicated cataract surgery under sub-tenon anaesthesia. Recovery of extrinsic motility was observed after corticosteroid and antihistamine treatment, but a non-haemorrhagic papillary oedema and a concentric defect of visual field were found. It progressed to papillary atrophy with preserved central vision, but with a significant visual field constriction. The aetiological study revealed an allergy to hyaluronidase that was used as adjuvant to the anaesthesia. This complication needs to be promptly diagnosed and treated, as the swelling of the orbital tissues can cause damage to the optic nerve.
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Affiliation(s)
- R Alcubierre
- Centre Ocular Quirúrgic de Sant Boi, Sant Boi de Llobregat, Barcelona, España; Departamento de Oftalmología, Hospital General de l'Hospitalet, Hospitalet de Llobregat, Barcelona, España.
| | - B F Sanchez-Dalmau
- Centre Ocular Quirúrgic de Sant Boi, Sant Boi de Llobregat, Barcelona, España; Departamento de Oftalmología, Hospital Clínic, Barcelona, España
| | - K Mousavi
- Centre Ocular Quirúrgic de Sant Boi, Sant Boi de Llobregat, Barcelona, España
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Raichura ND, Alam MS, Jaichandran VV, Mistry S, Mukherjee B. Hyaluronidase allergy mimicking orbital cellulitis. Orbit 2017; 37:149-153. [PMID: 29053033 DOI: 10.1080/01676830.2017.1383465] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Hyaluronidase enzyme is a common additive with local anesthetic agent to facilitate faster permeation of the anesthetic in periocular tissues during ophthalmic surgery. We report a series of five subjects presenting with clinical features mimicking orbital cellulitis following peribulbar anesthesia and consequently diagnosed with hyaluronidase hypersensitivity. SETTING The study was conducted at a tertiary eye care center in Southern India. DESIGN It was a retrospective interventional case series. METHODS We retrospectively reviewed the case records of patients diagnosed as and treated for hyaluronidase allergy from 2011 to 2015. The presenting features included periocular edema, proptosis, and restriction of ocular movements. The symptoms appeared immediately after the injection to as late as 6 days after the surgery. All patients underwent comprehensive ophthalmic evaluation, relevant investigations, and dermal allergy tests. All five patients tested positive for hyaluronidase. Patients were treated with antihistaminics, systemic steroids, and emergency orbital decompression, when required. In majority of the patients, symptoms resolved in 3-5 days. Clinically, hyaluronidase allergy may mimic orbital cellulitis, which in the context of a recent intraocular surgery may be alarming for both the patient and the surgeon. However, with prompt intervention, the prognosis is extremely favorable in cases of hyaluronidase allergy. It is important for ophthalmic surgeons and anesthetists to recognize and differentiate this entity from the more serious vision threatening conditions.
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Affiliation(s)
- Nirav D Raichura
- a Orbit, Oculoplasty, Reconstructive & Aesthetic Services , Sankara Nethralaya, Medical Research Foundation , Chennai , India
| | - Md Shahid Alam
- a Orbit, Oculoplasty, Reconstructive & Aesthetic Services , Sankara Nethralaya, Medical Research Foundation , Chennai , India
| | - V V Jaichandran
- b Department of Anesthesia , Sankara Nethralaya, Medical Research Foundation , Chennai , India
| | - Saurabh Mistry
- a Orbit, Oculoplasty, Reconstructive & Aesthetic Services , Sankara Nethralaya, Medical Research Foundation , Chennai , India
| | - Bipasha Mukherjee
- a Orbit, Oculoplasty, Reconstructive & Aesthetic Services , Sankara Nethralaya, Medical Research Foundation , Chennai , India
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8
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Rajalakshmi AR, Kumar MA. Hyaluronidase hypersensitivity: A rare complication of peribulbar block. Indian J Ophthalmol 2016; 64:160-2. [PMID: 27050356 PMCID: PMC4850816 DOI: 10.4103/0301-4738.179717] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Peribulbar block, though safe, can cause serious complications such as globe perforation and peribulbar hemorrhage. Hyaluronidase is an enzyme that is used as an adjuvant in peribulbar anesthesia, and it helps in rapid penetration of the anesthetic agent. Hypersensitivity to hyaluronidase is a rare but potentially sight-threatening complication. We report a case of hyaluronidase hypersensitivity following peribulbar injection for cataract surgery mimicking as peribulbar hematoma in the immediate postinjection phase and as orbital cellulitis 48 h later.
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Affiliation(s)
- A R Rajalakshmi
- Department of Ophthalmology, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
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9
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Abstract
BACKGROUND Most of the complications associated with hyaluronic acid (HA) fillers can be addressed by hyaluronidase. Extensive experience with this enzyme was accumulated in ophthalmology and anesthesia. In dermatologic use multiple aspects still remain controversial. OBJECTIVE To elucidate questions with regard to hyaluronidase use in HA-induced complications, including appropriate dosage, timing, and technique of delivery, differences in the activity of hyaluronidases of different origins, interaction between the enzymes and different HA gels, and safety issues. MATERIALS AND METHODS Extensive review of the relevant literature was conducted. The conclusions are based on this review and personal author's experience. RESULTS FDA-approved hyaluronidases provide predictable results and can be used interchangeably. A physician has to be closely familiar with specific characteristics of other hyaluronidases. Different brands of HA fillers have different sensitivity to degradation by hyaluronidase. For filler overcorrection or misplacement, low dose of the enzyme has to be injected directly into the palpable HA mass. In case of vascular accident, flushing of the ischemic area with high doses of hyaluronidase is required. Hypersensitivity reactions to hyaluronidase are so far not reported in dermatologic literature. CONCLUSION With increased popularity of HA fillers, hyaluronidase had become an indispensable tool in dermatology office. It is safe and reliable for treatment of HA-induced complications.
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10
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Yoo JH, Nam KY, Lee SU, Lee SJ. Orbital Apex Syndrome after Uneventful Phacoemulsification. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2016. [DOI: 10.3341/jkos.2016.57.12.1994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jae Ho Yoo
- Department of Ophthalmology, Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Ki Yup Nam
- Department of Ophthalmology, Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Seung Uk Lee
- Department of Ophthalmology, Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Sang Joon Lee
- Department of Ophthalmology, Gospel Hospital, Kosin University College of Medicine, Busan, Korea
- Institute for Medicine, Kosin University College of Medicine, Busan, Korea
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11
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Wohlrab J, Wohlrab D, Wohlrab L, Wohlrab C, Wohlrab A. Use of Hyaluronidase for Pharmacokinetic Increase in Bioavailability of Intracutaneously Applied Substances. Skin Pharmacol Physiol 2014; 27:276-82. [DOI: 10.1159/000360545] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 02/04/2014] [Indexed: 11/19/2022]
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12
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Cavallini M, Gazzola R, Metalla M, Vaienti L. The role of hyaluronidase in the treatment of complications from hyaluronic acid dermal fillers. Aesthet Surg J 2013; 33:1167-74. [PMID: 24197934 DOI: 10.1177/1090820x13511970] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Hyaluronidases, a family of enzymes that are able to degrade hyaluronic acid (HA), are employed in medicine to increase drug diffusion and reverse the effects of HA filler injections. Hyaluronidases are able to dissolve subcutaneous nodules or to correct excessive quantities of injected filler. Knowledge of the use, methods of application, and adverse effects of hyaluronidases is essential for the aesthetic practitioner. Therefore, we performed an extensive review of the available literature from 1928 to 2011 and compared the different enzymes available, recording each author's indications regarding usage and side effects.
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Abstract
Dermal filling has rapidly become one of the most common procedures performed by clinicians worldwide. The vast majority of treatments are successful and patient satisfaction is high. However, complications, both mild and severe, have been reported and result from injection of many different types of dermal fillers. In this Continuing Medical Education review article, the author describes common technical errors, the signs and symptoms of both common and rare complications, and management of sequelae in clear, easily adaptable treatment algorithms.
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14
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Chin YC, Kumar CM. Postoperative orbital swelling – Causes, diagnosis and management. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2013. [DOI: 10.1016/j.tacc.2013.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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15
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Zamora-Alejo K, Moore S, Leatherbarrow B, Norris JH, Lake DB, Malhotra R, Selva D, Goggin M. Hyaluronidase toxicity: a possible cause of postoperative periorbital inflammation. Clin Exp Ophthalmol 2012; 41:122-6. [DOI: 10.1111/j.1442-9071.2012.02834.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Lee HK, Choi EJ, Lee PB, Nahm FS. Anaphylactic shock caused by the epidurally-administered hyalurinidase. Korean J Pain 2011; 24:221-5. [PMID: 22220244 PMCID: PMC3248586 DOI: 10.3344/kjp.2011.24.4.221] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 11/11/2011] [Accepted: 11/11/2011] [Indexed: 11/17/2022] Open
Abstract
Hyaluronidase is an enzyme that has temporary and reversible enzymatic effects on the matrix of connective tissue. When added to local anesthetics in pain treatments, it enhances their infiltration and dispersal into tissues. It is widely used in anesthesia for ocular, dental, and plastic surgery. Reports of drug hypersensitivity to hyaluronidase are rare and are usually confined to peribulbar or retrobulbar anesthesia during ophthalmic surgery. However, few reports exist on adverse drug reaction after epidural injection. We have observed two patients experiencing anaphylactic shock caused by hyaluronidase following epidural injection. Most of the patients with a hypersensitivity to hyaluronidase had one previous uneventful injection containing hyaluronidase, implying that sensitization had taken place. However, hypersensitivity occurring at the first administration is possible. A positive skin test can help establish the diagnosis. Although rare, the possibility of an allergic reaction to hyaluronidase should be considered even in patients with no known previous exposure.
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Affiliation(s)
- Hae Kwang Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Kumar CM, Eid H, Dodds C. Sub-Tenon's anaesthesia: complications and their prevention. Eye (Lond) 2011; 25:694-703. [PMID: 21455245 DOI: 10.1038/eye.2011.69] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The advent of a new technique that is considered much safer than previously established one leads to its rapid adoption. This usually leads to the identification of previously unreported complications of the new technique, and a re-assessment of its position in clinical care, which is precisely the state of play with the sub-Tenon's block. The sub-Tenon's block was introduced into the clinical practice in early 1990. A systematic recent search of subject headings such as complications of sub-Tenon's block, subtenon, orbital block, orbital block complications, and orbital anaesthesia was performed in Medline, EMBASE, and Cochrane database. Indeed there are complications of sub-Tenon's block published as case reports and the exact incidence of these complications is not known. Management and preventive measures of these complications are described. Although the sub-Tenon's block appears to be relatively safer than needle-based blocks but a proper prospective, randomized, double-blind controlled trial is essential for scientific proof that sub-Tenon's block is better than needle-based blocks.
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Affiliation(s)
- C M Kumar
- Department of Anaesthesia, Khoo Teck Puat Hospital, Singapore, Singapore.
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Malik A, Fletcher EC, Chong V, Dasan J. Local anesthesia for cataract surgery. J Cataract Refract Surg 2010; 36:133-52. [PMID: 20117717 DOI: 10.1016/j.jcrs.2009.10.025] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2008] [Revised: 09/29/2009] [Accepted: 10/01/2009] [Indexed: 11/17/2022]
Abstract
Various aspects of local anesthesia for cataract surgery, such as the anesthetic agents and their interaction with ocular nerve supply, anesthesia requirements, available clinical techniques and their inherent complications are reviewed. A comparative evaluation of clinical techniques in terms of efficacy, akinesia, and patient-perceived pain during both anesthesia administration and intraoperative cataract surgery is presented, along with the prevailing practice patterns of anesthesia techniques among refractive surgeons in the United Kingdom and United States. More randomized clinical trials are needed to facilitate statistical methods of metaanalysis to establish convincingly the overall benefits and efficacy of the various local anesthesia procedures in cataract surgery. The wide scope of the present review is of relevance in structuring ophthalmology and anesthesia specialist training programs for junior staff.
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Affiliation(s)
- Adeela Malik
- Department of Ophthalmology, Epsom & St. Helier University Hospitals, Carshalton, United Kingdom.
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Etesse B, Beaudroit L, Deleuze M, Nouvellon E, Ripart J. [Hyaluronidase: Here we go again]. ACTA ACUST UNITED AC 2009; 28:658-65. [PMID: 19577408 DOI: 10.1016/j.annfar.2009.05.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2008] [Accepted: 05/20/2009] [Indexed: 11/25/2022]
Abstract
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. DATA SOURCES 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. STUDY SELECTION Original articles since 1949 were selected. We also selected isolated clinical cases according to their relevance compared with the existing literature. DATA SYNTHESIS 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. CONCLUSION 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.
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Affiliation(s)
- B Etesse
- Pôle Anesthésie-Douleur-urgences-Réanimation, Groupe Hospitalo-Universitaire Carémeau, 30029 Nîmes cedex 09, France
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Delaere L, Zeyen T, Foets B, Van Calster J, Stalmans I. Allergic reaction to hyaluronidase after retrobulbar anaesthesia: a case series and review. Int Ophthalmol 2008; 29:521-8. [DOI: 10.1007/s10792-008-9258-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2008] [Accepted: 07/11/2008] [Indexed: 11/24/2022]
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[Impact of hyaluronidase on anesthetic distribution in retrobulbar region following sub-Tenon anesthesia]. VOJNOSANIT PREGL 2008; 65:525-31. [PMID: 18700462 DOI: 10.2298/vsp0807525s] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIM Sub-Tenon's block is nowadays commonly used in ophthalmic surgery because of its safety and efficacy. The aim of this study was to investigate the distribution of the anaesthetic solution with different amounts of hyaluronidase in the retrobulbar space, following an injection into the Sub-Tenon's space. METHODS In this experimental study, 40 pig cadaver heads were used (80 eyeballs). The material was divided into four groups (of 20 eyeballs each). Each group was administered 4.5 ml of a mixture of 2% lignocaine, 0.5% bupivacaine, and 0.5 ml of Indian ink, with different amounts of hyaluronidase--15 IU/ml, 75 IU/ml, 150 IU/ml, except the control one. Samples of retrobulbar tissue were analysed using the standard histopathological procedure. After that, they were also analysed using the Adobe Photoshop program (Windows, USA). The retrobulbar space was divided into eight zones by four perpendicular lines, which crossed in the centre of the optic nerve. The presence of ink in fat and muscle tissues and in the sheath of the optic nerve was observed. RESULTS The presence of the local anaesthetic solution was significantly higher in inferonasal and superonasal quadrants of the fat and muscle tissues (p < 0.01). The distribution in optic nerve sheath is similar in each quadrant. Distribution of local anesthetic in each zone of the muscle tissue (I-VIII) was strongly influenced by the amount of hyaluronidase added. In the fat tissue, the distribution of local anesthetic under the influence of hyaluronidase was significantly higher (p < 0.05) in the areas which were distant from the place of injection (I-IV). The distribution in the optic nerve sheath is significantly higher (p < 0.01) in the group with 150 IU/ml of hyaluronidase. CONCLUSIONS Following a sub-Tenon block local anaesthetic was present in the retrobulbar space in a high percentage of the cases. The presence of local anaesthetic solution in retrobulbar space depends on the amount of hyaluronidase previously added to the local anaesthetic.
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Hyaluronidase increases the duration of mepivacaine in inferior alveolar nerve blocks. J Oral Maxillofac Surg 2008; 66:286-90. [PMID: 18201610 DOI: 10.1016/j.joms.2007.06.628] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2006] [Revised: 03/02/2007] [Accepted: 06/06/2007] [Indexed: 11/22/2022]
Abstract
PURPOSE To evaluate the duration of the effect of mepivacaine when hyaluronidase is injected immediately prior to the end of pulpal anesthesia. PATIENTS AND METHODS Forty bilateral, symmetrical third molar surgeries were performed in 20 healthy patients. Inferior alveolar nerve block was induced using 2.8 mL 2% mepivacaine with epinephrine. Hyaluronidase (75 turbidity-reducing units) or a placebo was injected 40 minutes after the beginning of pulpar anesthesia (randomized and double-blind trial). The duration of effect in the pulpal and gingival tissues was evaluated by response to painful electrical stimuli applied to the adjacent premolar, and by mechanical stimuli (pin prick) to the vestibular gingiva, respectively. RESULTS In both tissues, the duration of anesthetic effect with hyaluronidase was longer (P < .01) than with the placebo. CONCLUSION Hyaluronidase increases the duration of mepivacaine in inferior alveolar nerve blocks.
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Kozak I, Kayikcioglu OR, Cheng L, Falkenstein I, Silva GA, Yu DX, Freeman WR. The effect of recombinant human hyaluronidase on dexamethasone penetration into the posterior segment of the eye after sub-Tenon's injection. J Ocul Pharmacol Ther 2007; 22:362-9. [PMID: 17076631 DOI: 10.1089/jop.2006.22.362] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The aim of this study was to investigate the extent if recombinant human hyaluronidase (rhuPH20) can enhance trans-scleral penetration of sub-Tenon's dexamethasone (DM) into the posterior segment of the eye. METHODS rhuPH20 was purified from conditioned media through a series of ion exchange, hydrophobic interaction, aminophenylboronate, and hydroxyapatite chromatography to greater than 90% purity based upon specific activity. Only the right eye of each rabbit was injected. The first group (n = 16) received an injection of DM and rhuPH20, whereas the second group (n = 16) received DM only. The eyes were enucleated 1, 2, 3, and 6 h after the injection, and the choroid, retina, vitreous, aqueous, and serum were harvested. DM concentration was assessed by mass spectrometry. Histology (n = 2) and immunohistochemistry (n = 2) was performed to detect toxicity and the presence of the rHuPH20, respectively. RESULTS We observed no histopathologic damage to ocular tissues after sub-Tenon's injection. This enzyme significantly increased DM level in the choroid and the retina 3 h after administration. The rise in levels was transient returning to normal levels by 6 h. CONCLUSIONS Sub-Tenon's coinjection of rHuPH20 with DM resulted in a general increase in DM levels in ocular tissues and the serum, with significant increase in the choroid and the retina, 3 h after administration.
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Affiliation(s)
- Igor Kozak
- Jacobs Retina Center at the Shiley Eye Center, University of California-San Diego, La Jolla, CA 92037, USA
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Glaich AS, Cohen JL, Goldberg LH. Injection necrosis of the glabella: protocol for prevention and treatment after use of dermal fillers. Dermatol Surg 2006; 32:276-81. [PMID: 16442055 DOI: 10.1111/j.1524-4725.2006.32052.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Injection of filler materials into the dermis is well tolerated, with few mild and transient side effects. Injection necrosis is a rare but clinically important potential complication caused by interruption of the vascular supply to the area by compression, injury, and/or obstruction of the vessel(s). The glabella is a particular danger zone for injection necrosis regardless of the type of filler used. OBJECTIVE We recommend a protocol that may be used to help prevent and treat injection necrosis of the glabella after injection with dermal fillers. CONCLUSION Injection necrosis in the glabellar region may be prevented by knowledge of the local anatomy and an understanding of its pathophysiology and treated by a suggested protocol.
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Mukherji S, Esakowitz L. Orbital inflammation after sub-Tenon's anesthesia. J Cataract Refract Surg 2006; 31:2221-3. [PMID: 16412942 DOI: 10.1016/j.jcrs.2005.04.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2005] [Indexed: 10/25/2022]
Abstract
Two cases of orbital swelling after sub-Tenon's anesthesia are reported. The first patient presented 3 days postoperatively with proptosis and conjunctival chemosis. Computed tomography showed nonspecific inflammation of the orbital soft tissue. Signs and symptoms resolved after systemic steroids. The second patient presented with similar signs and mild pain on the fourth postoperative day. Computed tomography showed a similar diffuse orbital inflammation. The patient was treated with oral steroids and antibiotics, and all inflammation subsided within 4 weeks. Both patients had uneventful cataract surgery, were apyrexial, and were generally well. A few possible mechanisms for these episodes are infection, reaction to povidone-iodine or sub-Tenon's anesthetic, or trauma due to the sub-Tenon's cannula.
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Affiliation(s)
- Subhanjan Mukherji
- Registrar Department, Royal Alexandra Hospital, Paisley, Paisley, United Kingdom.
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Leibovitch I, Tamblyn D, Casson R, Selva D. Allergic reaction to hyaluronidase: a rare cause of orbital inflammation after cataract surgery. Graefes Arch Clin Exp Ophthalmol 2005; 244:944-9. [PMID: 16362314 DOI: 10.1007/s00417-005-0190-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2005] [Revised: 10/18/2005] [Accepted: 10/20/2005] [Indexed: 10/25/2022] Open
Abstract
PURPOSE The aim of this study was to present a series of patients with acute orbital inflammatory symptoms secondary to peribulbar hyaluronidase allergy and to discuss the diagnostic and management modalities. METHODS Review of clinical records of all patients with acute orbital inflammatory symptoms after uneventful cataract surgery, seen at two ophthalmology departments. The main outcome measures included clinical signs and symptoms, imaging findings, post-operative course, skin allergy testing, and final outcome. RESULTS There were five patients (four women, one man) with a mean age of 78+/-7.0 years. Signs and symptoms appeared 12-72 h after cataract surgery and included axial proptosis, periorbital erythema with swelling, and extraocular muscle (EOM) function restriction (5/5), periorbital pain or itchiness (3/5), and conjunctival chemosis (4/5). Computerized tomography showed increased orbital fat haziness and enlargement of EOM. Treatment with a combination of oral antibiotics and steroids or antihistamines resulted in resolution of signs and symptoms after 3-5 days. Intradermal and/or skin prick allergy tests were positive for hyaluronidase and negative for all other perioperative medications used. CONCLUSION Although uncommon, allergy to peribulbar hyaluronidase injected during cataract surgery should be considered in the differential diagnosis of patients who present with acute post-operative orbital signs and symptoms.
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Affiliation(s)
- Igal Leibovitch
- Oculoplastic & Orbital Division, Department of Ophthalmology & Visual Sciences, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, 5000, Australia.
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Ebo DG, Goossens S, Opsomer F, Bridts CH, Stevens WJ. Flow-assisted diagnosis of anaphylaxis to hyaluronidase. Allergy 2005; 60:1333-4. [PMID: 16135006 DOI: 10.1111/j.1398-9995.2005.00891.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- D G Ebo
- Immunology Allergology and Rheumatology University Antwerp Antwerpen Belgium.
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Patil B, Agius-Fernandez A, Worstmann T. Hyaluronidase allergy after peribulbar anesthesia with orbital inflammation. J Cataract Refract Surg 2005; 31:1480-1. [PMID: 16129269 DOI: 10.1016/j.jcrs.2005.08.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Vartanian AJ, Frankel AS, Rubin MG. Injected Hyaluronidase Reduces Restylane-Mediated Cutaneous Augmentation. ACTA ACUST UNITED AC 2005; 7:231-7. [PMID: 16027343 DOI: 10.1001/archfaci.7.4.231] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To determine the effects of injected hyaluronidase in cutaneous areas previously augmented with Restylane (Q-Med AB, Uppsala, Sweden), a nonanimal, stabilized hyaluronic acid (NASHA) gel. METHODS A prospective, randomized study was undertaken in 2 parts. First, the effects of hyaluronidase and saline were compared on post-NASHA dermal augmentation. Next, 3 different doses of hyaluronidase were evaluated after NASHA gel dermal augmentation. A blinded evaluator assigned postinjection skin scores. Each patient served as his or her own control. RESULTS Hyaluronidase dramatically reduced the size of the augmentation created by injected Restylane in all of our subjects. A comparison of average scores of saline-injected sites vs hyaluronidase-injected sites revealed a statistically significant difference. By 4 to 7 days after hyaluronidase injection, skin scores were at 20% of baseline (P<.001). Dose-related response to injected hyaluronidase was also observed, although it was not statistically significant. A number of patients (25%) demonstrated localized, self-limiting hypersensitivity reactions to injected hyaluronidase. CONCLUSIONS Intradermal hyaluronidase injections can be used to reduce dermal augmentation from previously injected Restylane. A small dose of hyaluronidase equivalent to 5 to 10 U may be injected initially.
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Affiliation(s)
- A John Vartanian
- Department of Otolaryngology--Head and Neck Surgery, University of Southern California, Los Angeles, USA.
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