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已发表论文
白内障手术球周麻醉后透明质酸酶超敏反应：两例病例报告
Authors Cheng C, Han Y, Liu X, Yu W, Yang N
Received 4 June 2025
Accepted for publication 3 February 2026
Published 10 February 2026 Volume 2026:18 543301
DOI https://doi.org/10.2147/DHPS.S543301
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 4
Editor who approved publication: Professor Siew Siang Chua
Cheng Cheng,1– 3 Yanfeng Han,1– 3 Xiaoxi Liu,1– 3 Weiwei Yu,1– 3 Nannan Yang1– 3
1Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, Shandong, People’s Republic of China; 2State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Eye Diseases, Qingdao, Shandong, People’s Republic of China; 3School of Ophthalmology, Shandong First Medical University, Jinan, Shandong, People’s Republic of China
Correspondence: Nannan Yang, Email 1191881483@qq.com
Background: Hypersensitivity reaction to hyaluronidase, though rare, can occur following regional anesthesia in ophthalmic surgery and may mimic serious conditions such as orbital cellulitis. Prompt recognition is critical to avoid misdiagnosis and unnecessary interventions.
Case Presentation: We report two cases of hypersensitivity reaction following hyaluronidase-augmented peribulbar anesthesia for cataract surgery. Case 1: A 90-year-old female with no prior allergy history developed progressive periorbital edema extending to the ipsilateral face and neck within 7 hours after surgery. Infection and hemorrhage were excluded via ultrasound. The reaction resolved promptly with antihistamines and systemic corticosteroids. Case 2: A 69-year-old female developed progressive bilateral periorbital edema extending to the forehead, accompanied by moderate pain within 7 hours postoperatively. While her C-reactive protein (CRP) level was within normal limits on the day of surgery, it rose significantly to 33.92 mg/L on postoperative day 1. Given this clinical and laboratory progression, an empirical and prophylactic therapeutic protocol was initiated, including a short course of systemic antibiotics alongside intensified anti-inflammatory treatment. All bacterial and fungal cultures returned negative, confirming a non-infectious etiology. Both patients achieved complete resolution of symptoms with uneventful recoveries maintained at both the one-week and one-month postoperative follow-up visits.
Conclusion: These cases illustrate that hyaluronidase hypersensitivity, though uncommon, should be considered in the differential diagnosis of acute postoperative periorbital inflammation. A combination of clinical vigilance, targeted imaging, and judicious use of laboratory tests is key to distinguishing this condition from infectious complications. Early diagnosis and a structured management approach are crucial to ensure patient safety and optimal outcomes.
Keywords: hyaluronidase, hypersensitivity reaction, allergy, peribulbar anesthesia, cataract surgery
1Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, Shandong, People’s Republic of China; 2State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Eye Diseases, Qingdao, Shandong, People’s Republic of China; 3School of Ophthalmology, Shandong First Medical University, Jinan, Shandong, People’s Republic of China
Correspondence: Nannan Yang, Email 1191881483@qq.com
Background: Hypersensitivity reaction to hyaluronidase, though rare, can occur following regional anesthesia in ophthalmic surgery and may mimic serious conditions such as orbital cellulitis. Prompt recognition is critical to avoid misdiagnosis and unnecessary interventions.
Case Presentation: We report two cases of hypersensitivity reaction following hyaluronidase-augmented peribulbar anesthesia for cataract surgery. Case 1: A 90-year-old female with no prior allergy history developed progressive periorbital edema extending to the ipsilateral face and neck within 7 hours after surgery. Infection and hemorrhage were excluded via ultrasound. The reaction resolved promptly with antihistamines and systemic corticosteroids. Case 2: A 69-year-old female developed progressive bilateral periorbital edema extending to the forehead, accompanied by moderate pain within 7 hours postoperatively. While her C-reactive protein (CRP) level was within normal limits on the day of surgery, it rose significantly to 33.92 mg/L on postoperative day 1. Given this clinical and laboratory progression, an empirical and prophylactic therapeutic protocol was initiated, including a short course of systemic antibiotics alongside intensified anti-inflammatory treatment. All bacterial and fungal cultures returned negative, confirming a non-infectious etiology. Both patients achieved complete resolution of symptoms with uneventful recoveries maintained at both the one-week and one-month postoperative follow-up visits.
Conclusion: These cases illustrate that hyaluronidase hypersensitivity, though uncommon, should be considered in the differential diagnosis of acute postoperative periorbital inflammation. A combination of clinical vigilance, targeted imaging, and judicious use of laboratory tests is key to distinguishing this condition from infectious complications. Early diagnosis and a structured management approach are crucial to ensure patient safety and optimal outcomes.
Keywords: hyaluronidase, hypersensitivity reaction, allergy, peribulbar anesthesia, cataract surgery