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Mark Harooni, MD; Jonathan M. Freilich, MD; Mark Abelson, MD; Miguel Refojo, DSc

Arch Ophthalmol. 1998;116:1218-1221.

Objective  To evaluate the efficacy of hyaluronidase in preventing increases in intraocular pressure related to injections of hyaluronan-containing viscoelastic substances.

Methods  Twenty-five white rabbits were divided into 5 groups. In groups 1 through 4, 0.15 mL of aqueous humor was removed and replaced with 0.10 mL of a viscoelastic substance in both eyes. Additionally, 10 units of hyaluronidase (0.05 mL) was injected in the anterior chamber of the right eye, whereas the left eye was injected with a volumetrically equivalent dose of balanced saline solution. Viscoelastic substances tested were Healon and Healon GV (Pharmacia & Upjohn, Kalamazoo, Mich), Viscoat (Alcon Laboratories, Fort Worth, Tex), and Ocucoat (Storz Ophthalmics, Clearwater, Fla). In group 5, right eyes were injected with 10 units of hyaluronidase and the left eyes were treated with balanced saline solution.

Results  After injections of viscoelastic substance, intraocular pressure rose rapidly, reaching a peak at approximately 46 hours after injection and returning to preinjection levels within 24 hours. Hyaluronidase significantly decreased intraocular pressure when used with Healon, Healon GV, and Viscoat, but not with Ocucoat. When injected in the absence of viscoelastic, hyaluronidase appeared to decrease intraocular pressure, but this result was not statistically significant.

Conclusions  Injections of hyaluronidase into the anterior chamber of rabbits effectively prevent increases in intraocular pressure induced by hyaluronan-containing viscoelastic substances. This effect may be related to the ability of hyaluronidase to cleave hyaluronan moieties.

From the Schepens Eye Research Institute, Harvard Medical School, Boston, Mass. Dr Harooni is now with the Department of Ophthalmology, State University of New York Health Science Center at Brooklyn, Brooklyn. The authors as well as the Schepens Eye Research Institute, Boston, Mass, do have a financial interest in the procedures described herein. The use of hyaluronidase in anterior chamber surgery is being considered for patent application by the Schepens Eye Research Institute and the authors.

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