Ingenuity method using viscoadaptive device to protect endothelial cell damage during cataract surgery

Yoshihiro Koide1

Contributing authors:Hiroyuki Matsushima1, Tadashi Senoo1, Kotaro Oki2

1Department of Opthalmology Dokkyo Medical University(Japan)2Oki Eye Surgery Center(Japan)

No Financial Interest

Remaining ophthalmic visco device (OVD) in anterior chamber (AC) during phacoemulcification 　 (PEA) is important to protect endothelial cells. In this study an ingenious method to remain OVD during PEA is evaluated.

Purpose

We found differences by method of injecting OVD for remaining in AC.

When the OVD inject from center of cornea, it is difficult to fill OVD on peripheral.

When the OVD inject from opposite side of incision, it is easy to fill out OVD completely.

Usual exchange Complete exchange

Is complete exchange effective? 1. Healon V (AMO) is prepared and stained

with fluorescein sodium for visualize.

2. Two different OVD exchange methods are performed to pig eyes.

3. Remained OVD is observed after PEA. Grade 0: OVD is disappeared from AC at end of PEA.Grade 1: OVD is partially remained in AC at end of PEA.Grade 2: OVD is remained in AC at end of PEA.

Is complete exchange effective?

The OVD partially disappeared after PEA.

The OVD still remained in AC after PEA.

Usual exchange Complete exchangePre Pre

PostPost

Is complete exchange effective?

0

1

2

0 0 .5 1 1 .5 2 2 .5

Usual exchange Complete exchange

Five surgeons tests the two different methods. The complete exchange is effective to remain OVD in AC after PEA.

Grade

Clinical evaluation

• 36 cataract patients are randomly separated into two groups.

V-group (18 eyes)Complete exchange by Healon V (AMO)

S-group (18 eyes)Soft-shell technique using Viscort (Alcon) and Healon (AMO)

Healon V

Viscort

Healon

Clinical evaluation• PEA is performed using Accurus (Alcon).

– Bottle height 60 cm,– Aspiration 160 mmHg, power 70%

• Percentages of corneal endothelial cell loss and ocular pressure are measured 1,3 and 6 months postoperatively.

• Unpaired t-test is performed for statistical analysis.

0.75

2.14

1.13

2.93

1.54

2.84

＊＊ ＊

The percentages of endothelial cell loss

＊ Unpaired t-test; P<0.05

The percentages of endothelial cell loss was lower in V- group than in S-group.

Intraocurar PressuremmHg

＊ There are no statistically significance.There are no differences of intraocular pressure preoperatively between two groups.

Conclusion

• Healon V was able to remain AC by ingenious complete exchange methods after PEA.

• Complete exchange AC using Healon V was effective to protect endothelial cell loss.

To protect endothelial cell loss…

• Not only the types of OVD but also the injection method of OVD during PEA were important to protect endothelial cell loss.

When the OVD inject from opposite side of incision, it is easy to fill out OVD completely.

Complete exchange