title: Endotoxins in ophthalmic viscosurgical devices.
abstract: OBJECTIVE
  To measure the endotoxin concentration (EC) of 25 commercially available, hyaluronic acid- and hydroxypropylmethylcellulose-based (HPMC) ophthalmic viscosurgical devices (OVDs).
  
  
  METHODS
  The in vitro Limulus amebocyte lysate (LAL) assay, which indicates the presence of endotoxins originating from gram-negative bacteria, was used to determine the EC. The procedure was performed according to the European Pharmacopoeia/USP. EC including duplicate determinations, negative controls, dilution series with control standard endotoxin, dilution series with sample extract and positive sample control.
  
  
  RESULTS
  16 OVDs (Amvisc, Amvisc Plus, Biolon, Coatel, Healon, Healon GV, Healon, HPMC Ophtal L, Microvisc, Microvisc Plus, Ocucoat, Provisc, Rayvisc, Viscoat, Visco Shield 2%, Visko 1.4%) had an EC under 1.2 endotoxin units/mL, five (Adatocel, HPMC Ophtal H, LA Gel, Viscorneal, Viscorneal Plus) had an EC > or = 1.2 and < or = 24 EU/ml, and four (Biocorneal, Dispasan also named Ophthalin, Dispasan Plus, Visko 1%) had an EC of > 24 EU/ml.
  
  
  CONCLUSIONS
  To avoid viscoelastic-related inflammatory or immunological reactions, the use of pure OVDs is recommended, especially for surgical procedures with an inherent possibility of leaving viscoelastic remnants in the eye (e.g., cataract surgery, visco-canalostomy or penetrating keratoplasty).
authors.affiliation: Department of Ophthalmology, Johannes Gutenberg University of Mainz, Germany. bdick@mail.uni-mainz.de
authors.forename: H Burkhard
authors.initials: HB
authors.lastname: Dick
authors.forename: A J
authors.initials: AJ
authors.lastname: Augustin
authors.forename: T
authors.initials: T
authors.lastname: Pakula
authors.forename: N
authors.initials: N
authors.lastname: Pfeiffer
mesh_terms: D009877:Endophthalmitis / Q000517:prevention & control; D004731:Endotoxins / Q000032:analysis*; D006090:Gram-Negative Bacteria; D006801:Humans; D006820:Hyaluronic Acid / Q000737:chemistry*; D007785:Lactose / Q000031:analogs & derivatives* / Q000737:chemistry*; D008033:Limulus Test; D008747:Methylcellulose / Q000031:analogs & derivatives* / Q000737:chemistry*; D013508:Ophthalmologic Surgical Procedures / Q000295:instrumentation*; D010078:Oxazines; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D004731:Endotoxins; D010078:Oxazines; D006820:Hyaluronic Acid; D008747:Methylcellulose; C071191:MK 458; D007785:Lactose