We have compared the efficacy of adding varying concentrations of hyaluroni
dase to a standard mixture of 2% lidocaine and 1% ropivacaine to provide pe
ribulbar anaesthesia for cataract surgery. We used (i) the time to adequate
anaesthesia for surgery and (ii) ocular and eyelid movement scores at 8 mi
n after block as clinical endpoints. Ninety patients were randomly allocate
d to receive 7-10 mi of equal volumes of 2% lidocaine and I% ropivacaine wi
thout hyaluronidase or with hyaluronidase 15 IU ml(-1) or 150 IU ml(-1). Me
dian time at which the block was adequate for surgery was 6 min in all grou
ps (interquartile range 4-12 min). Median eyelid movement scores were simil
ar in all groups, but the ocular movement scores at 8 min were significantl
y lower in the group which received hyaluronidase 150 IU ml(-1) than in the
group not given hyaluronidase (P <0.03). There were no differences between
groups in the incidence of minor complications. A high concentration of hy
aluronidase resulted in a statistically significantly lower ocular movement
score at 8 min; the clinical relevance of this finding is uncertain.