Purpose To compare the ophthalmic viscoelastic device (OVD) Healon®5 (sodium hyaluronate 2.3%) with 4 other commonly used OVDs during phacoemulsification and intraocular lens implantation in terms of influence on intraocular pressure (IOP) postoperatively and endothelial cells preoperatively and postoperatively. Setting Department of Ophthalmology, Ruprecht-Karls-University Heidelberg, Germany. Methods This clinical randomized prospective study, in which patients and observer were masked, comprised 81 eyes. Seventy-four eyes (mean patient age 71.2 years ± 7.8 [SD]) completed all preoperative and 5 postoperative examinations. The OVDs used were OcuCoat® and Celoftal® (hydroxypropyl methylcellulose 2.0%), Viscoat® (sodium hyaluronate 3.0%–chondroitin sulfate 4.0%), Healon GV® (sodium hyaluronate 1.4%), and Healon5 (sodium hyaluronate 2.3%). Intraocular pressure was measured by standard Goldmann applanation tonometry preoperatively and 4 to 6 and 24 hours and 7, 30, and 90 days postoperatively. Endothelial cell counts were done preoperatively and 90 days postoperatively using a Pro/Koester WFSCM contact endothelial microscope. Exclusion criteria were IOP greater than 21 mm Hg at the preoperative examination, age younger than 40 years, significant corneal pathology, and a history or presence of uveitis or pseudoexfoliation syndrome. Results All groups had increased IOP 4 hours postoperatively. The Healon5 group had the highest mean pressure (24.9 mm Hg) followed by the Viscoat group (23.6 mm Hg). The mean IOP in the other OVD groups was less than 22.1 mm Hg. These differences were not significant. Twenty-four hours postoperatively and at all subsequent examinations, mean IOP was below 20 mm Hg. The Healon5 group had the lowest mean endothelial cell loss (6.2%), significantly lower than in the other groups ( P Conclusion With all 5 OVDs, endothelial cell loss was found, with the lowest in the Healon5 group, and IOP was increased 4 to 6 hours postoperatively. After 24 hours, no significant increases in IOP were noted.

Effect of Healon5 and 4 other viscoelastic substances on intraocular pressure and endothelium after cataract surgery.

Purpose: To investigate the effect on intraocular pressure (IOP) of sutureless scleral and corneal tunnel Kelman phacoemulsification (KPE) with foldable posterior chamber intraocular lens (IOL) implantation. Setting: Jules Stein Eye Institute, Los Angeles, California, USA. Methods: Preoperative and postoperative (: and 6 weeks and 6 to 8 months) IOP measurements of 385 consecutive eyes. having uneventful phacoemulsification and foldable posterior chamber IOL implantation were reviewed retrospectively. A subset of 193 eyes for which no IOP measurements were missing at any follow-up were analyzed separately. Results: Mean preoperative IOP was 1,5.8 mm Hg ± 0.2 (±SE). It dropped postoperatively by 1,3 ± 0.2 mm Hg at 1 week ( P P P P P Conclusion: Sutureless KPE with foldable posterior chamber IOL implantation lowered IOP by 1.1 to 2.5 mm Hg for the 6 months immediately following surgery. Glaucoma patients had a statistically significant initial rise in IOP at 1 week.

Intraocular pressure change after sutureless phacoemulsification and foldable posterior chamber lens implantation.

Purpose To evaluate the effect of Healon®5 (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 P 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.

Intraocular pressure after small incision cataract surgery with Healon5 and Viscoat.

AIM To evaluate the effects of the dispersive viscoelastic agents Ocucoat (hydroxypropyl methylcellulose 2%) and Viscoat (sodium chondroitin sulphate 4%–sodium hyaluronate 3%) on postoperative intraocular pressure (IOP) after bilateral small incision cataract surgery. METHODS This prospective, randomised study comprised 80 eyes of 40 consecutive patients with age related cataract in both eyes scheduled for bilateral small incision cataract surgery. The patients were randomly assigned to receive Ocucoat or Viscoat during cataract surgery of the first eye. The second eye was operated later and received the other viscoelastic agent. Cataract surgery was performed with a temporal 3.2 mm sutureless posterior limbal incision, phacoemulsification, and implantation of a foldable silicone intraocular lens. The IOP was measured preoperatively as well as 6 hours, 20–24 hours, and 1 week postoperatively. RESULTS At 6 hours after surgery the mean IOP increased by 4.6 (SD 5.1) mm Hg in the Ocucoat group (p CONCLUSION These findings indicate that Viscoat causes a significantly higher IOP increase and significantly more IOP spikes than Ocucoat in the early period after small incision cataract surgery.

https://bjo.bmj.com/content/bjophthalmol/85/2/139.full.pdf

Intraocular pressure rise after small incision cataract surgery: a randomised intraindividual comparison of two dispersive viscoelastic agents

Keratoplasty evolved throughout the 20 century, beginning with the first clear graft in 1905, through the contributions of Castroviejo, Fine, Paton, and many others. By the mid 1970s, keratoplasty was a commonplace procedure with increasingly refined techniques. However, since that time, there have been numerous developments in the areas of trephination, suturing, combined procedures, adjunctive aids such as viscoelastics, and treatment of ensuing refractive errors. These will be reviewed here.

Techniques in penetrating keratoplasty: a quarter century of development.

Purpose: To evaluate transient increases in intraocular pressure (IOP) after use of high-viscosity viscoelastic agents in cataract surgery. Setting: Military Hospital, Ulm, Germany. Methods: In a prospective, randomized study, we evaluated IOP following cataract surgery using two different viscoelastic substances (Healon®, Healon® GV). The viscosity of Healon GV is 10 times higher than that of Healon because of higher concentration and molecular weight. Patients having identical phacoemulsification procedures (sutureless clear corneal tunnel incision with foldable silicone lens implantation) (N = 60) and identical viscoelastic removal were assigned to groups of 15 based on viscoelastic used and removal time (20 or 40 seconds). Intraocular pressure was measured preoperatively and at 6, 24, 36, and 48 hours and 1 month postoperatively. Results: The highest mean IOP elevations in both viscoelastic groups were obtained at 24 hours postoperatively (2.9 mm Hg ± 4.3 [SD] with Healon and 3.3 ± 6.3 mm Hg with Healon GV). There were no statistically significant differences between the two viscoelastics and the two removal times during the entire follow-up period (unpaired t-test), but standard deviations were higher in the Healon GV groups at 6 and 24 hours. Two patients in the Healon groups and three in the Healon GV groups required medical treatment for IOP within the first 24 postoperative hours; however, all five patients had an IOP lower than 22 mm Hg on the second postoperative day. Conclusions: Based on postoperative IOP, both viscoelastics can be equally well removed from the anterior chamber. Incidence of high IOP using high-viscosity hyaluronic acid is minimized by the described removal technique.

Evaluation of intraocular pressure with Healon and Healon GV in sutureless cataract surgery with foldable lens implantation

Background Viscoelastic substances are used in anterior segment surgery to reduce tissue trauma and endothelial cell loss and to serve as space maintainer Healon®GV ( greater viscosity), a hyaluronic acid product with a ten times higher viscosity than Healon®, is utilized in complicated procedures (vitreous pressure, flat anterior chamber, congenital cataracts, etc) and often in phacoemulsification Intraocular pressure (IOP) rise following incomplete removal is a known problem Materials and methods A prospective randomized study was performed to evaluate the IOP following cataract surgery with Healon® or Healon®GV and different removal times (RT) Forty patients (forty eyes) having uncomplicated phacoemulsification with foldable silicone posterior chamber lens implantation and identical viscoelastic removal technique were assigned to four groups : Healon® with 20 or 40 seconds (sec) RT, Healon®GV with 20 or 40 sec RT All surgeries were performed by the same surgeon using the same technique especially for the removal of the viscoelastic All patients had an identical pre- and postoperative medication Intraocular pressures were obtained using Goldman's applanation tonometry preoperatively, six, 24, 36, and 48 hours postoperatively Results The IOP follow-up showed no significant difference between the two viscoelastic substances and the two different removal times of 20 and 40 sec (t-test) In four patients (two of the Healon®-groups, two of the Healon®GV-groups) the IOP required treatment On the second postoperative day, the same four patients showed IOP lower than 22 mm Hg The highest mean-IOP (mm Hg) in both Healon-groups was obtained at 24 hours postoperatively: 185±39 SD (Healon®) ; 173±59 SD (Healon®GV) Conclusion The incidence of postoperative rise in IOP using high viscosity hyaluronic acid (Healon®GV) can be minimized by the applied removal technique Both viscoelastics - despite of higher molecular weight and viscosity - can be removed equally from the anterior chamber following phacoemulsification and posterior chamber lens implantation utilizing IOP as a parameter in vivo

Martin von Ehr

Papers

Evaluation of intraocular pressure with Healon and Healon GV in sutureless cataract surgery with foldable lens implantation

Postoperative intraocular pressure in the first days after intraocular administration of hyaluronic acid solution with different viscosities