Mechanistic Insights into the Multiple Functions of Niacinamide: Therapeutic Implications and Cosmeceutical Applications in Functional Skincare Products.

Niacinamide (or nicotinamide) is a small-molecule hydrosoluble vitamin with essential metabolic functions in mammalian cells. Niacinamide has become a key functional ingredient in diverse skincare products and cosmetics. This vitamin plays a pivotal role in NAD+ synthesis, notably contributing to redox reactions and energy production in cutaneous cells. Via diversified biochemical mechanisms, niacinamide is also known to influence human DNA repair and cellular stress responses. Based on decades of safe use in cosmetics, niacinamide recently gained widespread popularity as an active ingredient which aligns with the "Kligman standards" in skincare. From a therapeutic standpoint, the intrinsic properties of niacinamide may be applied to managing acne vulgaris, melasma, and psoriasis. From a cosmeceutical standpoint, niacinamide has been widely leveraged as a multipurpose antiaging ingredient. Therein, it was shown to significantly reduce cutaneous oxidative stress, inflammation, and pigmentation. Overall, through multimodal mechanisms, niacinamide may be considered to partially prevent and/or reverse several biophysical changes associated with skin aging. The present narrative review provides multifactorial insights into the mechanisms of niacinamide's therapeutic and cosmeceutical functions. The ingredient's evolving role in skincare was critically appraised, with a strong focus on the biochemical mechanisms at play. Finally, novel indications and potential applications of niacinamide in dermal fillers and alternative injectable formulations were prospectively explored.

The Double-Deck Viscoelastic Technique: a Novel Surgical Technique to Protect the Corneal Endothelium in Penetrating Keratoplasty of Aphakic Silicone Oil-Dependent Eyes after Severe Ocular Injury.

INTRODUCTION: The purpose of this study is to summarize the benefits of the double-deck viscoelastic technique (DDVT), a novel and cost-effective surgical technique that creates a barrier to hinder silicone oil (SO) from connecting and damaging the corneal endothelium in aphakic and SO-dependent eyes. METHODS: Five SO-dependent and aphakic eyes underwent double-deck viscoelastic embedment and penetrating keratoplasty (PKP) in this retrospective case series. At 1, 6, 12, 18, and 24 months after surgery, clinical outcomes including best corrected visual acuity (BCVA), intraocular pressure (IOP), corneal endothelial cell density (ECD), and double-deck viscoelastic layer imaging were evaluated. A Heidelberg Retina Tomograph confocal microscope was used to measure ECD. Ultrasound biomicroscopy (UBM) was used to image the double-deck viscoelastic layer. RESULTS: Postoperatively, the BCVA of the patients ranged from hand motion detection to 20/200, and their IOP was between 7 and 10 mmHg. The two-deck viscoelastic layer remained mostly static. Patients showed varying degrees of ECD reduction, with ECD loss rates in the first 6 months ranging from 6.7 to 75.8 cells/mm2/month and then declining to 2.2-14.3 cells/mm2/month. CONCLUSION: In SO-dependent aphakic eyes, double-deck viscoelastic embedment could effectively inhibit SO-corneal endothelium interaction. This technique could lower the pace of ECD loss and lengthen the time of corneal transparency, giving aphakic and silicone oil-dependent patients the opportunity to accept PKP surgery and get better vision quality.

Phacoemulsification and IOL-Implantation without Using Viscoelastics: Combined Modeling of Thermo Fluid Dynamics, Clinical Outcomes, and Endothelial Cell Density.

Phacoemulsification is a widely used surgical method in cataract surgery with a high energy ultrasound source. The viscoelastic is considered to be tissue protective. The aim of this study is to investigate during surgery the impact of using viscoelastic versus no viscoelastic on clinical outcomes, potential complications and effect on endothelial cell density. The study group included 64 patients, who were subjected to phacoemulsification using balanced salt solution (BSS). Control group consisted of 62 patients, who underwent phacoemulsification using Hyaloronic acid 1% Healon 1%. Student's t-test was applied for statistical analysis. The simulations of temperature changes during phacoemulsification were performed by COMSOL Multiphysics software. In the BSS group, a mean endothelial cell loss (ECL) of 4.5% was measured one month postoperatively, while in the Healon group ECL was 5.3%. Data analysis showed no significant difference in ECL between the groups (Student's t-test, p = 0.8). No significant difference was observed in endothelial cell morphology and IOP between the two groups pre- and postoperatively (all p > 0.05). The modeling of thermo fluid dynamics showed that the heating of the cornea is slightly less when Healon was used as irrigation fluid. The phacoemulsification technique can be performed by an experienced surgeon with viscoelastics or continuous anterior chamber (AC) irrigation on the same level of safety regarding endothelial cell damage, providing equally satisfying clinical outcomes.

Intracameral anesthetic mydriatic (ICAM) assisted pediatric cataract surgery.

PURPOSE: To assess the efficacy and safety of intracameral mydriatic and anesthetic combination for pupillary dilation in pediatric cataract surgery. METHODS: This prospective series included children <12 years, with visually significant unilateral or bilateral cataracts planned for cataract surgery with/without intraocular lens implantation. At the beginning of surgery, 0.025 ml of a combination of phenylephrine hydrochloride (0.31%), tropicamide (0.02%), and lidocaine hydrochloride (1%) was injected intracamerally. The efficacy of the combination was tested by achieving capsulorhexis and intraocular lens implantation without additional mydriatics. RESULTS: We recruited 13 patients (16 eyes) with a mean age of 4.1 ± 3.9 years. The mean pupillary diameter changed increased from 1.92 to 5.68 mm after injection of one unit (0.025 ml) of drug (p < 0.0001). There was a strong positive correlation of the pupillary dilation with axial length (R = 0.86) and horizontal corneal diameter (R = 0.81). Seventy-five percent patients had a pupillary diameter >6 mm and surgery could be completed successfully in all cases without additional mydriatics. In all cases, pupil dilated as the surgery progressed. No adverse event to the drug was noted. CONCLUSIONS: Intracameral mydriatic-anesthetic combination is an effective and safe way to obtain stable mydriasis in pediatric cataract surgery.

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.

Comparison of Floaters after Cataract Surgery with Different Viscoelastics.

Purpose: To investigate whether there is a difference between symptoms of floaters according to the type of ophthalmic viscosurgical devices(OVDs) used during phacoemulsification. Methods: A total of 112 eyes had undergone standard phacosurgery with the dispersive OVDs(Group1). Group2 comprised 117 eyes that underwent phacosurgery with the dispersive OVDs, but between continuous curvilinear capsulorhexis and hydrodissection, some OVDs had been removed. Group3 included 120 eyes that had undergone phacosurgery with the cohesive OVDs. Results: 14 eyes (12.5%) of Group1 had new-onset floater after surgery whereas 6 eyes (5.13%) in Group2, and 7 eyes (5.83%) in Group3 at the day after and a week after surgery. This was significantly higher in Group1 than Group2 and Group3, respectively (p=0.047,0.049). Conclusion: Cataract surgery with dispersive OVD can predispose the eye to an increased floater symptom. Therefore, surgeons should consider release some OVDs during hydrodissection with dispersive viscoelastics and keep trying to avoid IOP surge during surgery.

'Blue bubble' technique: an ab interno approach for Descemet separation in deep anterior lamellar keratoplasty using trypan blue stained viscoelastic device.

BACKGROUND: In this study, we examined a novel variant of 'big-bubble' deep anterior lamellar keratoplasty using trypan-blue-stained viscoelastic device for the creation of a pre-descemetic bubble. METHODS: Ten corneoscleral rims were mounted on an artificial anterior chamber (AC). The AC was filled with air through a limbal paracentesis. A Melles' triangulated spatula was inserted through the paracentesis, with its tip penetrating the AC, was then slightly retracted and pushed into the deep stroma above the roof of the paracentesis. A mixture of trypan blue and viscoelastic device (Healon, Abbott Medical Optics, Abbott Park, Illinois) was injected into this intra-stromal pocket using a 27-G cannula to create a pre-descemetic separation bubble. Bubble type and visualization of dyed viscoelastic device were noted. The method was later employed in three cases. RESULTS: In all 10 corneoscleral rims, the technique successfully created a visible pre-descemetic (type 1) bubble that could be expanded up to the predicted diameter of trephination. Subsequent trephination and the removal of corneal stroma were uneventful. In two out of four clinical cases, a type 1 bubble was created, while in two others, visco-dissection failed and dyed viscoelastic was seen in the AC. CONCLUSIONS: The presented technique holds promise of being a relatively easy to perform, predictable and well-controlled alternative for achieving a type 1 bubble during deep anterior lamellar keratoplasty surgery. The trypan-blue-stained viscoelastic device facilitates proper visualization and control of the separation bubble and assists in identifying the penetrance to the separation bubble prior to removal of the stromal cap.

Injectable Viscoelastic Supplements: A Review for Radiologists.

OBJECTIVE: Hyaluronic acid (HA) is increasingly used by musculoskeletal radiologists in the treatment of osteoarthritis (OA). Although the evidence base for its efficacy is controversial, it remains in common use. With initial evidence suggesting its efficacy in the knee, it is now offered for treating OA of the hip, ankle, and elsewhere. CONCLUSION: HA is available in a wide variety of preparations, which may vary in concentration and chemical composition. Clinicians offering intraarticular HA injection should be familiar with the common preparations available and the principal differences between them, its mechanism of action, and the profile of adverse effects associated with its use.

Lens: Management of Cataract Surgery, Cataract Prevention, and Floppy Iris Syndrome.

According to the World Health Organization, cataract is the major cause of reversible visual impairment in the world. It is present as the cause of decreased visual acuity in 33% of the visual impaired citizens. With the increase of life expectancy in the last decades, the number of patients with cataract is expected to grow for the next 20 years. Nowadays, the only effective treatment for cataracts is surgery and its surgical outcomes have been increasingly satisfactory with the technological advancement.Pharmaceutical development has been also responsible for surgical outcomes enhancement. This includes the development of new ophthalmic viscoelastic devices (OVDs), intraocular dyes, mydriatics, miotics, anesthetics, irrigating solutions, and antibiotics. However, the increased costs and demand for cataract surgery may be hard to meet in the future unless clinical preventive and curative options are evaluated.In this chapter, we review the studies that addressed pharmacological applications in cataract.

Viscoelastic characteristics of all cellulose suspension and nanocomposite.

We prepared cellulose nanocrystal (CNC)/carboxymethyl cellulose (CMC) suspensions and nanocomposites and carried out rheological analysis of the all-cellulose samples. Morphological observation of the prepared CNCs was conducted using transmission electron microscopy (TEM) and atomic force microscopy (AFM). The electrokinetic characteristic of the CNCs was evaluated from zeta potential measurement. A simple shear test, an oscillatory shear test, and dynamic mechanical analysis (DMA) were carried out, and their results were compared. The findings revealed that the greater shear-thinning behavior and more solid-like rheological behavior were observed with an increase in the content of CNCs embedded in both the suspensions and nanocomposites. In addition, the viscoelastic properties acquired in different experimental modes (i.e., shear and extension) were compared from a rheological perspective.

Long-term results of up to 12 years of over 700 cases of viscocanalostomy for open-angle glaucoma.

PURPOSE: To study the safety and long-term efficacy of classic viscocanalostomy in patients with open-angle glaucoma (OAG) in different populations. METHODS: A total of 726 eyes of 726 patients from Europe or South Africa with primary OAG (POAG) and pseudoexfoliative glaucoma (PXFG) were included in this retrospective multicentre study. Complete (qualified) success was defined as an intraocular pressure (IOP) equal to or lower than 21, 18 and 16 mmHg without (with or without) medications, respectively. A failed procedure was defined if IOP was above 21 mmHg, not controllable by laser goniopuncture or medications. RESULTS: The mean IOP before surgery was 42.6 ± 14.2 mmHg for all patients, 29.6 ± 6.6 mmHg for European patients and 48.1 ± 12.9 mmHg for African patients. The follow-up time was 86.2 ± 43.1 months. Mean IOP was 15.4 ± 3.6 mmHg at 5 years, 15.5 ± 4.4 mmHg at 10 years and 16.8 ± 4.2 mmHg at 15 years. The qualified success rate for an IOP of 21, 18 or 16 mmHg or less after 5 years was 92% [95% confidence interval (CI) 0.88-0.96], 70% (95% CI 0.63-0.77) and 43% (95% CI 0.36-0.51) in European patients, and 90% (95% CI 0.87-0.93), 77% (95% CI 0.74-0.81) and 67% (95% CI 0.63-0.72) in African patients, respectively. There was no difference between the success rate for POAG and PXFG for an IOP of 21, 18 or 16 mmHg or less at 5 years (p = 0.64, p = 0.20, p = 0.22, respectively). Laser goniopuncture was performed postoperatively on a total of 127 eyes (17.7%), lowering the pressure from 23.1 ± 1.9 mmHg to 15.0 ± 2.2 mmHg. There were no significant complications, in particular, no blebitis or endophthalmitis. CONCLUSION: Viscocanalostomy produced a sustained long-term reduction of IOP with a low-risk profile in European and African patients with OAG over 12 years.

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.

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.