超声乳化术中不同粘弹剂(Viscoat和透明质酸钠)对角膜内皮细胞的影响

目的　比较两种粘弹性物质Viscoat和透明质酸钠在白内障超声乳化手术中对角膜内皮的影响。方法　老年性白内障 49人 68眼 ,其中透明质酸钠组 2 5人 3 4眼 ,Viscoat组 2 4人 3 4眼 ,两组患者无内眼病史、眼外伤及眼内手术史 ,无糖尿病等全身疾病史。采用超声乳化术摘出白内障同时植入折叠性人工晶体 ,术前术后用非接触型角膜内皮显微镜观察测量角膜内皮细胞密度。结果　二组一般情况包括年龄 ,晶体核硬度及超声能量与时间的乘积无显著性差异 (P >0 0 5 ) ;透明质酸钠组术前和术后的角膜内皮细胞丢失率为 15 % ,经统计学处理有统计学意义 (P <0 0 5 )。Viscoat组术前和术后的角膜内皮细胞丢失率为 9% ,经统计学处理没有显普性差异 (P >0 0 5 )。结论　在白内障超声乳化手术中粘弹剂Viscoat对角膜内皮细胞的保护能力强于透明质酸钠     

Transient corneal edema after phacoemulsification: comparison of 3 viscoelastic regimens

PURPOSE: To evaluate the effect of different viscoelastic substances on the grade and time course of postoperative corneal edema. SETTING: Department of Clinical Sciences/Ophthalmology, Ume? University Hospital, Ume?, Sweden. METHODS: This study comprised 62 patients with otherwise healthy eyes who had routine phacoemulsification and intraocular lens (IOL) implantation. Patients were divided into 3 groups. Group 1 was given Healon GV (sodium hyaluronate 1.4%) at phacoemulsification and IOL implantation. Group 2 was given Viscoat (sodium hyaluronate 3.0%-chondroitin sulfate 4.0%) at phacoemulsification and Healon GV at IOL implantation. Group 3 was given Viscoat at phacoemulsification and Provisc (sodium hyaluronate 1.0%) at lens implantation. The central corneal thickness was measured with ultrasonic pachymetry before surgery and 5 and 24 hours, 1 week, and 1 month after surgery. RESULTS: The mean increase in corneal thickness was significantly greater in Group 1 than in the other 2 groups 5 and 24 hours and 1 week after surgery. CONCLUSIONS: The transient postoperative increase in central corneal thickness was greater in patients receiving Healon GV during phacoemulsification than in patients receiving Viscoat. The use of Provisc or Healon GV for IOL implantation did not affect the postoperative corneal thickness when Viscoat was used for phacoemulsification. The time course of the edema may be explained by a difference between the 2 agents in endothelial protection from ultrasonic, mechanical, or irrigation trauma.     

Comparison of BD Multivisc with the soft shell technique in cases with hard lens nucleus and Fuchs endothelial dystrophy

PURPOSE: To compare the efficacy of 2.5% sodium hyaluronate (BD Multivisc) with the soft shell technique in reducing corneal endothelial cell damage during cataract phacoemulsification in patients with hard lens nucleus (3+) and cornea guttata. METHODS: Thirty patients (37 eyes) scheduled for cataract surgery at Department of Ophthalmology and Visual Sciences, University Hospital San Raffaele, Milano, Italy. Thirty-seven eyes (randomly divided into Groups A and B) with hard lens nucleus (grade 3 or higher) and cornea guttata had phacoemulsification using the soft shell technique (Group A) with Biolon (sodium hyaluronate 1%) and Viscoat (sodium hyaluronate 3%-chondroitin sulfate 4%) or with BD Multivisc alone (Group B). Patients were evaluated preoperatively and after 1, 15, 90, and 180 days, checked for best-corrected visual acuity (BCVA), intraocular pressure (IOP), central corneal thickness, and corneal endothelial density. Stop and chop phacoemulsification technique, with burst mode (Alcon Legacy 20000, Advantec), was performed. RESULTS: There were no significant differences between the two groups at 3 and 6 months in BCVA, IOP, corneal thickness, or endothelial cell density. The increase of central corneal thickness (preoperative: Group A 584+/-30 microm, Group B 573+/-30 microm; postoperative at 90 days: Group A 593+/-38 microm, Group B 577+/-25 microm) was not significant. Endothelial cell loss was similar in both groups. CONCLUSIONS: The results suggest that the soft shell technique (Biolon, Viscoat) and 2.5% sodium hyaluronate (BD Multivisc) are both effective in protecting the corneal endothelium in Fuchs dystrophy during phacoemulsification in patients with hard lens nucleus.     

The influence of viscoelastic substances on the corneal endothelial cell population during cataract surgery: a prospective study of cohesive and dispersive viscoelastics

PURPOSE: To compare the ability of cohesive and dispersive ophthalmic viscoelastic devices (OVDs) to protect the corneal endothelium following in-the-bag phacoemulsification with implantation of a foldable posterior chamber intraocular lens (IOL). METHODS: In a prospective single-masked randomized study, 60 eyes of 60 cataract patients were assigned to three groups of 20 patients each, according to which OVD was used: Celoftal, Vitrax or Healon. The corneal response to surgery was evaluated by measuring the endothelial cell loss, the variation in mean cell area of the endothelial cells (CV), the frequency of hexagonal cells, and the central corneal thickness. Data were recorded preoperatively and 3 months postoperatively. RESULTS: Preoperatively, no significant difference was observed in cell count, CV, hexagonal pattern or pachymetry among groups. Postoperatively, all three groups had a significant decrease in cell count, but the decrease was significantly less in the Vitrax group (6.97%) than in the Celoftal (18.03%) and Healon groups (18.46%). No changes in CV, hexagonality or corneal thickness were observed within any of the three groups or among the groups. There was an equal and significant increase in visual acuity. CONCLUSIONS: Phacoemulsification with implantation of a posterior chamber lens is known to affect the density and morphology of corneal endothelial cells. Viscoelastics facilitate cataract surgery and protect the corneal endothelium during the procedure. Choosing a dispersive hyaluronate OVD during the phaco procedure may allow for protection of the endothelial cells while suppressing the formation of free radicals. This may be the reason for the superior protective effect on the corneal endothelial cells of Vitrax compared with Celoftal and Healon.     

Clinical comparison of Healon5 and Healon in phacoemulsification and intraocular lens implantation; Randomized multicenter study

PURPOSE: To compare the overall clinical performance during phacoemulsification and intraocular lens (IOL) implantation, the effect on intraocular pressure (IOP), and the effect on corneal endothelium of Healon5 (sodium hyaluronate 2.3%) and Healon (sodium hyaluronate 1.0%) ophthalmic viscosurgical devices (OVDs). SETTING: Multicenter study. METHODS: In this randomized prospective clinical study, the performance of Healon5 (viscoadaptive; dispersive and cohesive) and Healon (cohesive) during cataract surgery was evaluated in 157 patients, 79 with Healon5 and 78 with Healon. Surgeons evaluated the following on a 5-point scale: retention during phacoemulsification (primary endpoint), ease of injection, anterior chamber maintenance during continuous curvilinear capsulorhexis (CCC), facilitation of IOL implantation, and ease of removal from the eye. Masked examiners other than the surgeon performed the following measurements: IOP preoperatively and 5 and 24 hours, 7 days, and 3 months postoperatively; corneal thickness before and 24 hours, 7 days, and 3 months postoperatively; and corneal endothelial cell count preoperatively and 3 months postoperatively. RESULTS: Intraocular retention during phacoemulsification was assessed as good or very good in 77% in the Healon5 group and 8% in the Healon group; the difference was statistically significant (P<.0001, Wilcoxon rank sum test). The Healon5 group had significantly better scores for anterior chamber maintenance during CCC (P<.0001) and facilitation of IOL implantation (P =.032), and the Healon group had significantly better scores for ease of injection (P<.0001) and ease of removal (P<.0001). There were no statistically significant between-group differences in IOP, corneal endothelial cell count, or corneal thickness. CONCLUSIONS: Surgeons rated Healon5 better than Healon in retention during phacoemulsification, anterior chamber maintenance during CCC, and facilitation of IOL implantation. They assessed Healon as easier to inject and remove. There was no difference in safety-related parameters between the 2 OVDs. These findings indicate that Healon5 is effective in cataract surgery.     

不同粘弹剂在复杂性白内障超声乳化术中的临床观察

目的:比较两种粘弹性物质DuoVisc和透明质酸钠(其胜)在复杂性白内障超声乳化术中对角膜切口水肿及角膜内皮的影响。方法:将复杂性白内障(抗青光眼术后小瞳孔、陈旧性虹膜炎瞳孔后粘连)106眼,随机分成2组,其中透明质酸钠A组(其胜)53眼;其中抗青光眼术后小瞳孔21眼、陈旧性虹膜炎瞳孔后粘连32眼。DuoVisc组B组53眼;其中抗青光眼术后小瞳孔23眼、陈旧性虹膜炎瞳孔后粘连30眼。两组患者在白内障术前均有青光眼病史(且均有抗青光眼手术史)和陈旧性虹膜炎史。部分患者曾行两次以上抗青光眼手术,所有患者无糖尿病等全身疾病史。采用超声乳化白内障摘除联合折叠人工晶状体植入术,术前术后采用非接触式角膜内皮镜(NONCON ROBO SP60000)于术前、术后1wk和术后1,3mo对角膜内皮细胞进行随访观察,并对中央区0.25mm×0.37mm范围内进行计数密度测量。结果:两组一般情况包括年龄、超声能量与时间的乘积无显著性差异(P>0.05);两组术前测量角膜内皮数无显著性差异(P>0.05);术后1d,1wk角膜水肿的患者B组明显轻于A组(P<0.01);当角膜水肿为(++~+++)时、角膜内皮损伤、丢失的修复在术后1wk,1mo内B组明显优于A组(P<0.01);术后3mo2组比较差异无显著性(P>0.05)。结论:在复杂性白内障超声乳化术中使用粘弹剂DuoVisc对减少角膜术后水肿及对角膜内皮细胞的保护明显优于透明质酸钠(其胜)。     

Effectiveness of the soft-shell technique in patients with Fuchs' endothelial dystrophy

PURPOSE: To evaluate the protective ability of the soft-shell technique in patients with senile cataract and Fuchs' dystrophy having phacoemulsification with intraocular lens (IOL) implantation. SETTING: Department of Ophthalmology, Railway Hospital, Katowice, Poland. METHODS: Sixty-one eyes of 54 patients (37 women, 17 men) with clinically confirmed Fuchs' dystrophy and cataract had clear corneal phacoemulsification and implantation of an intracapsular posterior chamber IOL with sodium hyaluronate 1% (Healon) or chondroitin sulfate 4%-sodium hyaluronate 3% (Viscoat) in combination with sodium hyaluronate 1% (Provisc) in 1 package (DuoVisc). The central corneal thickness (CCT), measured with a Pocket Precision ultrasonic pachymeter (Quantel Medical, Inc.), was compared preoperatively and 1 day, 1 week, and 1 and 6 months postoperatively. RESULTS: The mean preoperative CCT was 549.5 microm +/- 29.3 (SD). The postoperative increase in CCT over preoperative pachymetry measurements remained statistically significant in both ophthalmic viscosurgical device groups throughout the entire follow-up, from the first day to the sixth month after surgery (P<.0001). The maximum increase in CCT in both groups was on the first postoperative day, and it was significantly higher in the Healon group. Six months postoperatively, patients in the Healon group had a significantly greater CCT increase (P = .008). CONCLUSION: The soft-shell technique effectively protected the compromised endothelium in patients with Fuchs' dystrophy, proving its advantages in eyes with moderately damaged endothelium.     

Efficacy and safety of the soft-shell technique in cases with a hard lens nucleus

PURPOSE: To evaluate the efficacy and safety of the soft-shell technique in reducing corneal endothelial cell damage during cataract surgery in patients with a hard lens nucleus. SETTING: Miyata Eye Hospital, Miyakonojo, Miyazaki, Japan. METHODS: Sixty eyes of 57 cataract patients with a hard lens nucleus (Emery-Little classification grade 3 or higher) had phacoemulsification using the soft-shell technique with Healon((R)) (sodium hyaluronate 1%) and Viscoat (sodium hyaluronate 3.0%-chondroitin sulfate 4.0%) (soft-shell group) or with Healon alone (control group). The visual acuity, intraocular pressure (IOP), flare intensity in the anterior chamber, central corneal thickness, and corneal endothelial cell density were evaluated postoperatively. RESULTS: There were no significant IOP elevations in either group. The mean central corneal thickness in the control group was 539 microm +/- 26.0 (SD) preoperatively and 578 +/- 52.0 microm 1 day after surgery; the increase was significant (P =.0154). There was no significant change in the central corneal thickness in the soft-shell group. There were no statistically significant differences between the 2 groups in uncorrected visual acuity, best corrected visual acuity, IOP, flare intensity in the anterior chamber, and central corneal thickness throughout the follow-up. The rate of endothelial cell loss 3 months after surgery was 6.4% +/- 9.6% in the soft-shell group and 16.3% +/- 9.8% in the control group (P =.0003). CONCLUSION: The results suggest that the soft-shell technique is safe and effective in protecting corneal endothelial cells during cataract surgery in patients with a hard lens nucleus.     

DuoVisc黏弹剂对白内障超声乳化术低密度角膜内皮细胞的保护作用

目的:临床观察DuoVisc黏弹剂对白内障超声乳化术中低密度角膜内皮细胞的保护效果。方法:观察12例角膜内皮细胞密度为652.9～930.3个/mm²的白内障超乳手术眼,术前记录角膜内皮细胞密度、中央角膜厚度,行白内障超声乳化吸出及后房型折叠人工晶状体植入术,术中应用DuoVisc黏弹剂,术后观察角膜内皮细胞变化,计算术后7d内角膜内皮细胞密度及中央角膜厚度。结果:术后早期部分角膜轻度水肿,药物治疗后恢复透明,术后7d内角膜内皮细胞密度为735.6±92.6个/mm²,较术前（798.2±113.1个/mm²）无明显减少(P=0.145),中央角膜厚度（0.53±0.02mm）正常,同术前（0.51± 0.014mm）相比差异无统计学意义(P=0.144)。结论:熟练掌握超声乳化术的情况下,应用DuoVisc黏弹剂行角膜内皮细胞密度低者的白内障超声乳化术是可行的。     

Efficacy of the soft-shell technique using Viscoat and Hyal-2000

PURPOSE: To evaluate whether the soft-shell technique using Viscoat (sodium hyaluronate 3%-chondroitin sulfate 4%) and Hyal-2000 (sodium hyaluronate 1%) reduces corneal endothelial cell damage during cataract surgery. SETTING: Department of Ophthalmology, Kangnam St. Mary's Hospital, Seoul, Korea. METHODS: The nuclear opacity in 252 eyes of 230 cataract patients was classified as grade 1, 2, 3, or > or =4 using the Lens Opacities Classification System III. In each classification, the patients were divided into 4 groups before phacoemulsification based on the type of ophthalmic viscosurgical device (OVD) used during surgery: Viscoat and Hyal-2000 (soft-shell technique), Viscoat alone, Hyal-2000 alone, or Provisc (sodium hyaluronate 1%) alone. All patients were operated on using the same technique except for the OVD. The visual acuity, corneal endothelial cell density, corneal thickness, and intraocular pressure (IOP) were evaluated postoperatively. RESULTS: The rate of endothelial cell loss 2 months after surgery in eyes with a nuclear opacity grade of > or =4 was significantly different between the 4 OVD groups. The rate in eyes with a nuclear opacity grade of < or =3 was not significantly different between the groups. There were no statistically significant differences between the 4 groups in visual acuity, corneal thickness, or IOP throughout the follow-up period. CONCLUSION: The soft-shell technique using Viscoat and Hyal-2000 protected corneal endothelial cells during cataract surgery in patients with a nuclear opacity grade of > or =4.     

The Clinical Study of Healon 5 in Phacoemulsification and IOL Implantation

Purpose: To compare a new ophthalmic viscoelastic device (OVD) Healon 5 with two other kinds of OVDs commonly used in China during phacoemulsification and intraocular lens (IOL) implantation in terms of removal time, intraocular pressure, corneal and anterior chamber response.Methods: This prospective randomized study, in which patients and observers are masked, comprises niety eyes. They were randomly divided into 3 groups with different OVDs. Healon 5 (sodium hyaluronate 5 000 2.3%) was compared with Healon GV (sodium hyaluronate 7 000 1.4%) and Iviz (sodium hyaluronate 1.0%) . The surgeries were performed with temporal corneal incision, phacoemulsification in situ and foldable lens intracapsular implantation. The characteristic and the removal time of the viscoelastic material as well as the postoperative IOP, corneal reaction and anterior chamber reactions of the eyes were observed preoperatively and 24 hrs postoperatively. Exclusion criteria were glaucoma, a preoperative dilated pupil diameter small     

Scheimpflug photography study of ophthalmic viscosurgical devices during simulated cataract surgery

PURPOSE: To evaluate by Scheimpflug photography the capacity of several commercially available ophthalmic viscosurgical devices (OVDs) to remain in the anterior chamber and maintain anterior chamber depth (ACD) during simulated cataract surgery in porcine cadaver eyes. SETTING: Department of Preclinical Ophthalmology, Pharmacia & Upjohn AB, Uppsala, Sweden. METHODS: Eighty eyes from newly slaughtered pigs were used. They were distributed equally among 8 OVDs: Amvisc Plus (sodium hyaluronate 1.6%), Biolon (sodium hyaluronate 1.0%), Biolon Prime (sodium hyaluronate 1.2%), Healon (sodium hyaluronate 1.0%), Healon GV (sodium hyaluronate 1.4%), Healon5 (sodium hyaluronate 2.3%), Provisc (sodium hyaluronate 1.0%), and Viscoat (sodium hyaluronate 3.0%-chondroitin sulfate 4.0%). Scheimpflug photographs were taken using a Nidek EAS-1000 instrument before surgery (control), after injection of the OVD, after continuous curvilinear capsulorhexis (CCC), and after lens extraction by phacoemulsification. Differences in the ACD with a P value less than 0.05 were considered statistically significant. The retention capacity was visually assessed. RESULTS: Healon5 had a significantly higher capacity to maintain the ACD than the other OVDs after CCC and phacoemulsification. After injection, Healon5, Viscoat, and Biolon Prime showed similar ACD-maintaining capacities. CONCLUSIONS: The capacity of Healon5 to maintain the ACD during cataract surgery, ie, neutralizing the vitreous pressure and stabilizing the anterior segment of the eye, was significantly higher than that of the other OVDs.     

Viscoelastic protection from endothelial damage by air bubbles

PURPOSE: To determine whether viscoelastic materials effectively protect the corneal endothelium from air bubbles. SETTING: Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea. METHODS: Human eye-bank and rabbit eyes had a standardized phacoemulsification procedure with or without viscoelastic material (Healon [sodium hyaluronate 1.0%], Healon GV [sodium hyaluronate 1.4%], or Viscoat [chondroitin sulfate 4.0%-sodium hyaluronate 3.0%]). The integrity of the endothelium was examined after the procedure with F-actin staining and scanning electron microscopy. Rabbit eyes with and without viscoelastic material (Healon or Viscoat) had a standardized irrigation/aspiration (I/A) procedure. The mucinous layer of the endothelium was examined after the procedure with transmission electron microscopy. RESULTS: In the phacoemulsification experiment without viscoelastic material, with Healon, and with Healon GV, the endothelium of human and rabbit corneas had many areas of cell loss in a pattern consistent with air-bubble damage. With Viscoat, endothelial cells remained intact. In the I/A experiment, the mucinous layer of Viscoat-exposed rabbit endothelium appeared thinner. In the same experiments without viscoelastic material or with Healon, the mucinous layer of the endothelium appeared normal. CONCLUSIONS: Viscoat effectively protected the endothelium from air-bubble damage. Viscoat appears to protect the endothelium by acting as a physical barrier. Its adherence is probably related to the way it interacts with the mucinous layer of the endothelium.     

Intraocular pressure after small incision cataract surgery with Healon5 and Viscoat

PURPOSE: To evaluate the effect of Healon5 (sodium hyaluronate) and Viscoat (sodium chondroitin sulfate-sodium hyaluronate) on intraocular pressure (IOP) after bilateral small incision cataract surgery. SETTING: Department of Ophthalmology, University of Vienna, Vienna, Austria. METHODS: This prospective randomized study comprised 70 eyes of 35 consecutive patients with age-related cataract in both eyes scheduled for bilateral small incision cataract surgery. The patients were randomly assigned to receive Healon5 or Viscoat during cataract surgery in the first eye. The second eye received the other viscoelastic substance. Cataract surgery was performed in an identical fashion in both eyes, with a temporal 3.5 mm sutureless posterior limbal incision, phacoemulsification, and implantation of a foldable silicone intraocular lens. The IOP was measured preoperatively and 6 hours, 20 to 24 hours, and 1 week postoperatively. RESULTS: At 6 hours after surgery, the mean IOP increased by 5.2 mm Hg +/- 5.3 (SD) in the Healon5 group (P < .0001) and by 10.1 +/- 8.7 mm Hg in the Viscoat group (P < .0001). The increase was significantly higher in the Viscoat group than in the Healon5 group (P = .0016). Intraocular pressure spikes of 30 mm Hg or more occurred in 2 eyes in the Healon5 group and in 10 eyes in the Viscoat group (P = .0112). Twenty to 24 hours and 1 week postoperatively, the mean IOP in the 2 groups was not statistically different. CONCLUSIONS: Viscoat caused a significantly higher IOP increase and significantly more IOP spikes than Healon5 in the early period after small incision cataract surgery.     

Corneal endothelial cell protection during phacoemulsification: low- versus high-molecular-weight sodium hyaluronate

PURPOSE: To compare the efficacy of low- and high-molecular-weight sodium hyaluronate in protecting corneal endothelial cells during phacoemulsification. SETTING: Miyata Eye Hospital, Miyakonojo, Miyazaki, Japan. METHODS: One hundred forty-nine eyes of 136 cataract patients were randomly assigned to have cataract surgery using sodium hyaluronate 1% with a low molecular weight (0.6 to 1.2 million d, Opegan) or sodium hyaluronate 1% with a high molecular weight (4 million d, Healon) during phacoemulsification. Each group was divided into 2 subgroups depending on the amount of ultrasound (% min) used during phacoemulsification, which was defined as the mean phacoemulsification energy (%) multiplied by phacoemulsification time (minutes). Corneal endothelial cell density was examined preoperatively and 3 months after surgery. The rate of cell loss was compared between the subgroups in the Opegan group and the Healon group. RESULTS: In the subgroups with ultrasound of 50% min or less, the mean rate of endothelial cell loss 3 months after surgery was 3.2% +/- 4.1% (SD) in the Opegan group and 5.9% +/- 5.3% in the Healon group (P =.0214). In the subgroups with ultrasound over 50% min, the mean rate of endothelial cell loss 3 months after surgery was 7.5% +/- 10.6% in the Opegan group and 14.8 +/- 9.0% in the Healon group (P =.0029). CONCLUSIONS: The results suggest that Opegan is more effective than Healon in protecting corneal endothelial cells during phacoemulsification regardless of the amount of ultrasound energy used.     

Endothelial cell loss after cataract phacoemulsification with Healon5 vs. I-Visc Phaco

BACKGROUND: Healon5, the first viscoadaptive agent introduced in ophthalmic surgery, has been judged to be superior to Healon GV in protecting corneal endothelial cells. The purpose of this study was to compare the endothelial protective effects of I-Visc Phaco, a newer viscoadaptive agent, with those of Healon5 in cataract phacoemulsification. METHODS: A total of 96 unselected patients scheduled to undergo cataract surgery at a community-based hospital in St. Catharines, Ont., were assigned to receive I-Visc Phaco. This group was compared with 112 patients who had received Healon5 in a previous study by the author. The technique used to remove the cataract with phacoemulsification and insertion of an intraocular lens was the same in the two groups. Endothelial cell count and corneal thickness were measured preoperatively and 3 and 8 weeks postoperatively with a Konan noncontact specular microscope. One-way analysis of variance was used to analyse the data. RESULTS: Preoperatively there was no statistically significant difference between the Healon5 and I-Visc Phaco groups in age, eye operated, or endothelial cell count or corneal thickness. At 3 weeks there was no significant difference between the two groups in mean endothelial cell count (2110.2 [standard deviation (SD) 529.9] cells/mm2 vs. 2113.5 [SD 566.6] cells/mm2) or mean corneal thickness (586.2 microm [SD 46.73 microm] vs. 583.9 microm [SD 42.23 microm]). Similarly, there was no significant difference between the two groups in mean endothelial cell count (2113.3 [SD 496.6] cells/mm2 vs. 2145.5 [SD 573.1] cells/mm2) or mean corneal thickness (570.9 microm [SD 44.09 microm] vs. 574.4 microm [SD 40.73 microm]) at 8 weeks. INTERPRETATION: Results at 3 and 8 weeks postoperatively indicate that Healon5 and I-Visc Phaco protect the endothelium equally well during cataract phacoemulsification surgery.     

Corneal edema and intraocular pressure after cataract surgery: randomized comparison of Healon5 and Amvisc Plus

PURPOSE: To compare the protective effect of Healon5 (sodium hyaluronate 2.3%) and Amvisc Plus (sodium hyaluronate 1.6%) against corneal edema and their association with postoperative intraocular pressure (IOP) spikes in patients having phacoemulsification and intraocular lens (IOL) implantation. SETTING: Ophthalmology department of a general hospital. METHODS: One hundred forty patients were randomly assigned to have surgery with Healon5 (n = 70) or Amvisc Plus (n = 70). One eye of each patient was analyzed. Data collected preoperatively included best corrected visual acuity (BCVA) and IOP. Central ultrasonic pachymetry was performed in all patients. The same ophthalmologist performed all surgeries. The IOP and central corneal thickness (CCT) were measured 1 and 4 days and 1 month after surgery. The BCVA was also assessed at 1 month. RESULTS: There were no significant preoperative differences between the Healon5 and Amvisc Plus groups in sex, age, ocular pathology, BCVA, IOP, or CCT. Intraoperative variables were similar between groups, but it took significantly longer to remove the Healon5. Postoperatively, there were no differences between groups in the evolution of CCT or of IOP. Intraocular pressure spikes over 30 mm Hg were detected at 1 day in 7 patients in the Healon5 group and 2 patients in the Amvisc Plus group (10.0% versus 2.9%; P = .165). CONCLUSIONS: Both OVDs were beneficial in a wide range of cataract patients. However, the results suggest a tendency toward a higher complication rate with Healon5.     

壳多糖在白内障人工晶状体植入术中的应用

比较壳多糖与透明质酸钠作为粘弹剂在白内障人工晶状体手术中的作用。方法对１４０例白内障随机分组,分别彩和ＥＣＣＥ＋ＩＯＬ或超声乳化吸出ＩＯＬ两种手术方法。７０眼术中用壳多糖作为粘弹剂使用,７０眼用透明质酸钠作为对照。结果术后矫正视力,角膜内皮,前房反应以及眼压变化,壳多糖组与透明质酸钠组均无显著差异。     

Clinical results of phacoemulsification with the use of Healon5 or Viscoat

PURPOSE: To compare the ophthalmic viscosurgical devices Healon5 (viscoadaptive) and Viscoat (dispersive) regarding their overall clinical performance during phacoemulsification and posterior chamber intraocular lens (IOL) implantation as well as their influence on intraocular pressure (IOP). SETTING: Department of Ophthalmology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany. METHODS: In this prospective randomized patient- and observer-masked clinical study, the performance of Healon5 (sodium hyaluronate 2.3%) and Viscoat (sodium hyaluronate 3.0%-chondroitin sulfate 4.0%) was assessed by 3 surgeons during cataract surgery in 90 patients. Surgeons used a 5-point scale for the subjective assessment of the ease of injection, maintenance capacity during continuous curvilinear capsulorhexis, remaining capacity during phacoemulsification, facilitation of IOL implantation, removal from the eye, transparency, and overall performance throughout surgery. Intraocular pressure was measured preoperatively and 24 hours and 7 days postoperatively. Best corrected visual acuity was assessed preoperatively and 7 days postoperatively. RESULTS: Overall intraoperative product performance was assessed as good or very good in 34 of 44 patients (77%) in the Healon5 group and in 16 of 46 patients (35%) in the Viscoat group (P <.001). Retention in the anterior chamber was graded good or very good in 36 patients (82%) in the Healon5 group and in 23 (50%) in the Viscoat group (P =.001). There were no statistically significant between-group differences in mean IOP preoperatively and 24 hours postoperatively. CONCLUSIONS: Surgeons graded Healon5 better than Viscoat in overall surgical performance and retention in the anterior chamber during phacoemulsification. These data support that Healon5 adapts to each step during surgery.