Changes of anterior chamber structure in patients after combined surgery of glaucoma and cataract with viscoelastics injection under the sclera valve / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate the changes of anterior chamber structure in patients after combined surgery of glaucoma and cataract with viscoelastics injection under the sclera valve by OCT. <p>METHODS: The cataract with acute glaucoma patients who underwent combined surgery of glaucoma and cataract from 2016 to 2018 were enrolled. The patients were divided into the viscoelastics group and the control group. The anterior chamber depth(ACD), the angle opening distance(AOD₅₀₀)and the trabecular iris angle(TIA)were examined to compare the changes of the anterior chamber structure between the two groups. <p>RESULTS: At 1 and 3d after surgery, the ACD(3.82±0.51,3.71±0.63, 3.78±0.33mm), the angle opening distance(AOD₅₀₀: 0.25±0.04, 0.24±0.04, 0.25±0.05mm)and the TIA(25.13°±8.06°, 26.18°±8.06°, 29.25°±6.22°)were statistically different between two groups. There was no significant difference on the ACD, the AOD₅₀₀ and the TIA of the two groups 7d after surgery(<i>P</i><0.05).<p>CONCLUSION: Viscoelastics injection under the sclera valve can deepen the anterior chamber effectively after combined surgery of glaucoma and cataract. It avoids the occurrence of shallow anterior chamber in the early postoperation and maintains the opening of anterior chamber.

Augmentation of Filtering Blebs with Viscoelastics in Trabeculectomy

PURPOSE: To evaluate the clinical outcome of viscoelastics (VE, sodium hyaluronate)-augmented trabeculectomy (VAT, 66 eyes) and conventional trabeculectomy (CT, 57 eyes) for glaucomatous eyes. METHODS: In the VAT group, half of the anterior chamber space was filled with VE via the paracentesis site at the end of CT and a balanced salt solution was injected into the anterior chamber. This procedure induced migration of VE from the anterior chamber into the bleb space; thus the bleb was elevated with underlying VE. Follow-up examinations were performed until 1 year after surgery. Success was defined as the attainment of an intraocular pressure (IOP) greater than 5 mmHg and less than 22 mmHg. If IOP was in the range of success without antiglaucoma medication, it was regarded as a complete success. RESULTS: The mean postoperative IOP was significantly lower in the VAT group at postoperative 1 day, 1 week, and 1 month. The complete success rate was significantly higher in the VAT group (89%) than in the CT group (75%), though the qualified success rate was not different between the two groups. The number of IOP-lowering medications at postoperative 1 year was significantly higher in the CT group (1.30 ± 1.08 vs. 0.73 ± 0.98, p = 0.003). Among postoperative procedures, laser suture lysis was required less frequently in the VAT group (p < 0.001). CONCLUSIONS: Placing VE within the bleb at the end of surgery may result in better IOP control and less need for IOP-lowering medication without any additional materials, cost, or time.

Protective Effects of Viscoelastic Substances on air Bubble Damage During Phacoemulsification

PURPOSE: To determine whether viscoelastic materials are effective to protect the corneal endothelium from air bubble damage. METHODS: Human eye bank (n=12) and rabbit (n=22) eyes underwent a standardized phacoemulsification procedure with or without viscoelastic material [1% sodium hyaluronate (Healon(R)), 1.4% sodium hyaluronate (Healon GV(R)), 3% sodium hyaluronate with 4% chondroitin sulfate (Viscoat(R))]. The integrity of the endothelium was examined after the procedure with F-actin staining and scanning electron microscopy (SEM). RESULTS: In the phacoemulsification experiment without viscoelastic material, with Healon, and with Healon GV, the endothelium of both human and rabbit corneas had many areas of cell loss in a pattern consistent with air bubble damage. But with Viscoat, endothelial cells remained intact. CONCLUSIONS: We found that Viscoat was effective to protect the endothelium from air bubble damage. Viscoat seems to protect the endothelium by acting as a physical barrier.

Efficacy and Safety of Commerical Used Viscoelastics: Healon(R), Provisc(R), Viscorneal(R), Hyal 2000(R), Biolon(R), Viscoat(R)

Several different viscoelastic substances are widely used in many ophthalmologic fields. In our study, the efficacy and safety of the different kinds of viscoelastics -Healon(R), Provisc(R), Viscorenal(R), Hyal-2000(R), Viscoat(R) and Biolon(R)-was evaluated in undergoing phacoemulsification and posterior intraocular lens implantation, corneal transplantation and ocular trauma surgery. We evaluated and the facility of the injection the foreign materials during injection of viscoelastics through the microscopy. We measured the changes of intraocular pressure at the postoperative 1 day and corneal endothelial cell count at the postoperative 2 month. The mean endothelial cell loss after phacoemulsification and posterior intraocular lens implantation was 13.71% at postoperative 1 day and there was no significantly different among groups. The incidence of the foreign materials including air bubles in viscoelastics in the operating microscope was Provisc(R), Hyal 2000 Viscorneal(R), Biolon(R), Healon(R) in order. The mean incidence of the intraocular pressure above 25 mmHg after cataract surgery at postoperative 1 day was 3.94%and was Hyal 2000(R), Biolon(R), Viscorneal(R), Healon(R), Provisc(R) in order. The incidence of the additional use of the antiglaucoma drugs in keratoplasty patients was 76%in Healon(R) group, 26.7%in Viscoat(R) group, 69.2%in Provisc(R) group respectively. From the results of this report, we conclude that it is desirable to use the proper viscoelastics according to the chemical and physical properties in special situations, but there is no significant difference in the same viscoelastic substance.

Effect of Hyaluronic Acid on the Experimental Corneal Endothelial Damage by Hydrogen Peroxide

To investigate the protective effect of hyaluronic acid on the corneal endothelial damage induced by perfusion with hydrogen peroxide, rabbit corneas were mounted in the in vitro dual-chambered specular microscope and perfused with glutathione-bicarbonate-ringer(GBR) solution for one hour, and test agents for additional two hours. Test agents were hydrogen acid(0.01%). and chondroitin sulfate(0.04%). Corneal thickness was measured every 15 minutes during the perfusion and a corneal swelling rate was calculated by linear regression analysis. At the end of perfusion, corneas were fixed for transmission electron microscopy(TEM). Hydrogen peroxide(0.5mM) caused marked corneal swelling white 0.25mM did not(65.95+/-8.03 vs. 6.69+/-2.58micrometer/hr). Healon prevented the H2O2 induced corneal swelling(15.85+/-2.99micrometer/hr) and maintained the endothelial ultrastructures. Viscoat enabled the corneas to deswell(-35.90+/-18.04micrometer/hr). Hyaluronic acid(0.01%) and catalase(15000U) also prevented corneal swelling induced by hydrogen peroxide(9.52+/-3.61, 4.61+/-0.99micrometer/hr respectively), and maintained the endothelial ultrastructure, however 0.04% chondroitin sulfate showed marked corneal swelling(71.73+/-2.12micrometer/hr). The results of this study showed that Healon and Viscoat containing hyaluronic acid could protect corneal endothelial cells from hydrogen peroxide.

Evaluation of New Viscoelatics in Rabbit: Healon, Healon GV, Provisc

Viscoelastic substance which is one of the most important thing in anterior segment surgery sells many kinds as to its unique properties. The complications during its use are acute postoperative intraocular pressure elevation, corneal edema, severe ocular pain, blurred vision. The extent of elevation, peak time and normalized time of intraocular pressure can be varied by operative technique, amount of residual viscoelastics in anterior chamber, kinds of viscoelastics. To compare the safety of Healon GV and Provisc with Healon, we injected the same amount of those three viscoelastics into anterior chamber of 27 rabbits divided by three groups and examined the degree and change of intraocular pressure elevation, corneal edema, intraocular inflammation, maintenance of anterior chamber. Healon GV showed the persistent intraocular pressure elevation immediately after injection and normalized at 24 hours. Healon and Provisc showed elevated pressure at 7 and 5 hour but normalized within 12 hour. Corneal thickness increased significantly at 1 to 7 hour in Healon and Healon GV group and continued to 24 hour in Healon GV group and there was no significant pressure change in Provisc group compared with preinjection status. There were no significant differences in intraocular inflammation, amintenance of anterior chamber between three viscoelastics. Healon GV shoed more frequent, higher intraocular pressure elevation as compared to the other two viscoelastics, but pressure was normalized within 24 hour. From the above results, it is concluded that Healon GV can be used well with caution and Provisc can be used widespreadly due to its minor complication, too.

Clinical Comparison of Three Viscoealsitcs: Healon, healon GV, Provisc

Viscoelastics which are used in intraocular surgery sell many kinds as to its unique properties. We intended to valuate the clinical usefulness of three viscoelastics, Healon, Healon GV and Provisc. We performed phacoemulsificatioin and posterior chamber intraocular lens implantation in 26, 28, 29 eyes with each viscoelastics and measured the corneal thickness at preoperatively, postoperative 1 day, 1 week, 1 month, 2 months, 5 months and endothelial cell count at preoperatively, postoperative 2 months. We also analysed the anterior chamber maintenance and easiness of injection and removal during operation, In Healon used group, Preoperative corneal thickness was 549.7+/-24.3micrometer, in Healon GV group, 550.1+/-28.7micrometer, in Provisc group, 543.1+/-39.0micrometer and which were changed into 552.1+/-39.0micrometer, 533.1+/-21.1micrometer, 522.2+/-32.0micrometer at postoperative 5 months respectively, but there was no statistically significant difference between preoperative and postoperative status in all three groups. There was a tendency of slight reduction of endothelial cell count at postoperative 2 month in three groups, but it wasn`t statistically significant, too. Healon GV and Provisc were better in anterior chamber maintenance but injection into anterior chamber and removal by irrigation and aspiration were more easy in Healon used group. So, we suggest all three viscoelastics has hood endothelial protective effect and can be used freely as to their unique properties and the operative situation.

Change of Intraocular Pressure Induced by Viscoelastics in Cataract Surgery with Intentional Posterior Capsule Ruptrue

The cataract surgery with viscoelastic agent was performed in forty eyes of twenty rabbits which were divided into two groups, one group with intact posterior capsule and the other group with ruptured posterior capsule of the lens, to evaluate the effect of viscoelastic agents on IOP according to presence of the intact posterior capsule of the lens after cataract surgery. The viscoelastics used were Healon in control group, and Healon, Viscoat and Occucoat in experimental group. We checked the IOP during one month. Peak IOP after surgery and the time from surgery to the peak IOP showed no difference between two groups. In experimental group, there was no difference in the change of postoperative IOP according to the kind of viscoelastics. Results suggest that the rupture of posterior capsule of the lens plays a role in delayed excretion of the viscoelastics, and the postoperative elevation of IOP was not different regardless of the physical difference of Viscoelastics.