Intraocular irrigating solutions. A clinical study of BSS Plus and dextrose bicarbonate fortified BSS as an infusate during pars plana vitrectomy.
OBJECTIVE
To compare the effect of Balanced Salt Solution Plus (BSS Plus, Alcon Laboratories, Fort Worth, Texas, USA) and fortified regular BSS on the cornea and lens, when used for continuous irrigation in pars plana vitrectomy (PPV) surgery.


METHODS
Prospective, investigator masked, randomised study. Forty patients were randomly assigned to undergo PPV using BSS Plus (n=20) or fortified BSS (n=20) [regular BSS, fortified with 10.5 cc. of dextrose in water (D5W) and 13.1 cc. of 8.4% sodium bicarbonate]. Intraoperative features of the corneal epithelium, postoperative changes in the corneal endothelial cell denstiy (ECD) at 3 months, and clarity of the lens during surgery and postoperatively were evaluated.


RESULTS
Intraoperative epithelial changes were similar in both groups with 7 (35%) of the cases having the epithelium removed in the BSS Plus group and 8 (40%) in the BSS fortified group (P=0.23). The mean differences in ECD (3 months versus preoperative) in the operated eyes when adjusted for changes in the control eye showed no difference with the type of BSS (P=0.98). Intraoperative lens changes were more significant (P=0.018) in the BSS fortified group. Postoperative lens status at 3 months was similar for both groups. Though there was a trend towards worse postoperative nuclear sclerosis change in the BSS fortified group, it was not significant (P=0.160).


CONCLUSIONS
Standard BSS fortified with dextrose and bicarbonate is an efficacious infusion fluid during pars plana vitrectomy. Both solutions showed comparable effects on postoperative corneal endothelial cell density and corneal epithelial changes intraoperatively. BSS fortified has more lenticular changes intraoperatively than BSS Plus although no lens had to be removed in either group. The study implications are important since BSS fortified is significantly less expensive than BSS Plus.
Samuel
Michael A
MA
Henry Ford Health System, Detroit, MI 48202, USA.
Desai
Uday R
UR
Strassman
Israel
I
Abusamak
Mohammed
M
D000085:Acetates / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D001639:Bicarbonates / Q000008:administration & dosage*; D002452:Cell Count; D003315:Cornea / Q000187:drug effects; D004338:Drug Combinations; D005260:Female; D005947:Glucose / Q000008:administration & dosage*; D005978:Glutathione / Q000008:administration & dosage*; D006801:Humans; D007432:Intraoperative Period; D007552:Isotonic Solutions / Q000008:administration & dosage; D019654:Lens Implantation, Intraocular / Q000379:methods; D007908:Lens, Crystalline / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D008903:Minerals / Q000008:administration & dosage*; D009883:Ophthalmic Solutions / Q000008:administration & dosage; D011183:Postoperative Complications; D011446:Prospective Studies; D012965:Sodium Chloride / Q000008:administration & dosage*; D007507:Therapeutic Irrigation / Q000379:methods; D014821:Vitrectomy / Q000379:methods*
D000085:Acetates; C030660:BSS solution; D001639:Bicarbonates; D004338:Drug Combinations; D007552:Isotonic Solutions; D008903:Minerals; D009883:Ophthalmic Solutions; C013003:glutathione-bicarbonate-Ringer solution; D012965:Sodium Chloride; D005978:Glutathione; D005947:Glucose