Role of Hyaluronidase in Orbital Mass Excision

Abstract

Background: Hyaluronidase belongs to a family of enzymes that degrades hyaluronic acid, which is a constituent of the extracellular matrix. The property of hyaluronidase to help relieve tissue adhesions has found implications in epidural neuroplasty, failed back surgery syndrome, abdominal adhesions, and in prevention of formation of adhesions postoperatively in laparoscopic ventral hernia repair. There is no previous study supporting the role of hyaluronidase in relieving the adhesions around the orbital masses and aiding in their delivery. This article intends to discuss the utility of hyaluronidase in orbital mass excision by relieving adhesions around the mass. Aim:The purpose of this article is to describe the successful use of hyaluronidase intraoperatively for excision of orbital cavernous hemangioma. This patient had an orbital cavernous hemangioma of 8 years' duration. Materials and methods:This report describes a patient who presented with unilateral proptosis of long-standing duration and visual diminution of 6 months' duration. Radiological imaging showed presence of intraconal cavernous hemangioma in the right orbit. The patient underwent transconjunctival orbitotomy for orbital mass excision. Intraoperatively, 5 mL of injection hyaluronidase 300 IU/mL diluted in balanced salt solution was injected around the mass for adhesiolysis using a 25-gauge cannula. Conclusion:The intraoperative use of hyaluronidase helped in relieving the adhesions around the mass and helped in its easy delivery without undue manipulation.Clinical significance: Hyaluronidase is helpful in adhesiolysis around the orbital masses and promotes their easy delivery. This helps in early recovery and decreased postoperative tissue edema. This is first such report implicating the role of hyaluronidase in orbital mass excision.