Protective effect of free-radical scavengers on corneal endothelial damage in phacoemulsification.
OBJECTIVE
To examine the role of the water-soluble antioxidants glutathione and ascorbic acid in the irrigating solution on corneal endothelial cells following exposure to high-intensity ultrasound energy.


METHODS
Goldschleger Eye Research Institute, Sheba Medical Center, Tel-Aviv University, Tel Aviv, Israel.


METHODS
Thirty-two rabbit eyes were subjected to prolonged exposure to the phacoemulsification device in the anterior chamber. The eyes were divided into 4 groups that differed only in the composition of the irrigating solution applied to the eyes: balanced salt solution (BSS) BSS Plus BSS containing additional soluble components including glutathione, BSS with 10(-3) M of oxidized glutathione (GSSG), and BSS with 10(-2) M of ascorbic acid. Specular microscopy was performed preoperatively and 1 week after surgery.


RESULTS
The BSS group exhibited the highest endothelial cell loss (19.3%), followed by the BSS Plus group (10.6%), the GSSG group (5.2%), and the ascorbic acid group (0.9%). An overall difference was found between the groups (F = 11.046, P<.0001), and all groups demonstrated a statistically significant difference from the control BSS group (P<.02, P = .001, and P<.0001, respectively).


CONCLUSIONS
Damage to the cornea is largely due to the free radicals generated by high-intensity ultrasound energy during phacoemulsification. Adding the antioxidants ascorbic acid and GSSG to the irrigation solution significantly reduced the endothelial corneal cell damage. Ascorbic acid in the concentration of 10(-2) M had the highest protective effect; thus, it should be evaluated for clinical use.
Nemet
Arie Y
AY
Department of Ophthalmology, Meir Hospital, Sapir Medical Center, Kfar-Saba, Israel. nemet.arik@gmail.com
Assia
Ehud I
EI
Meyerstein
Dan
D
Meyerstein
Naomi
N
Gedanken
Aharon
A
Topaz
Morris
M
D000085:Acetates / Q000494:pharmacology; D000818:Animals; D000975:Antioxidants / Q000494:pharmacology*; D001205:Ascorbic Acid / Q000494:pharmacology*; D002452:Cell Count; D019610:Cytoprotection; D004338:Drug Combinations; D004728:Endothelium, Corneal / Q000187:drug effects*; D005260:Female; D016166:Free Radical Scavengers / Q000494:pharmacology*; D005978:Glutathione / Q000494:pharmacology*; D008903:Minerals / Q000494:pharmacology; D018918:Phacoemulsification; D011817:Rabbits; D012965:Sodium Chloride / Q000494:pharmacology; D007507:Therapeutic Irrigation
D000085:Acetates; D000975:Antioxidants; C030660:BSS solution; D004338:Drug Combinations; D016166:Free Radical Scavengers; D008903:Minerals; D012965:Sodium Chloride; D005978:Glutathione; D001205:Ascorbic Acid