Soft-shell technique using Viscoat and Healon 5: a prospective, randomized comparison between a dispersive-viscoadaptive and a dispersive-cohesive soft-shell technique.
OBJECTIVE
To compare the efficacy of the dispersive-viscoadaptive soft-shell technique using Viscoat and Healon 5 to the dispersive-cohesive soft-shell technique in reducing corneal endothelial cell damage during cataract surgery.


METHODS
In this prospective randomized study, 207 eyes of 171 cataract patients underwent phacoemulsification using the dispersive-viscoadaptive soft-shell technique (V-group, 102 eyes) with Viscoat and Healon5 or the dispersive-cohesive soft-shell technique (C-group, 105 eyes) with Viscoat and a cohesive agent (Opegan-Hi). Each group was divided into two subgroups depending on the amount of ultrasound (%Min) used during phacoemulsification. Corneal endothelial cell density was examined preoperatively and 3 months postoperatively. The endothelial cell loss was compared between the two groups, and also between the subgroups.


RESULTS
The mean endothelial cell loss 3 months after surgery was 8.4 +/- 5.6% standard deviation (SD) in the V-group and 8.2 +/- 6.2% in the C-group (P = 0.787). In the subgroups with ultrasound of 10 %Min or less, the mean endothelial cell loss 3 months after surgery was 6.6 +/- 4.6% in the V-group and 5.5 +/- 5.0% in the C-group (P = 0.104). In the subgroups with ultrasound of over 10 %Min, this value was 10.6 +/- 6.3% in the V-group and 11.9 +/- 5.7% in the C-group (P = 0.413). The correlation coefficient of the endothelial cell loss rate and %Min was 0.245 (P = 0.0129) in the V-group and 0.501 (P < 0.0001) in the C-group.


CONCLUSIONS
The dispersive-viscoadaptive soft-shell technique is as effective as the dispersive-cohesive soft-shell technique in protecting corneal endothelial cells during phacoemulsification regardless of the amount of ultrasound energy used.
Sato
Masaki
M
Department of Ophthalmology, Institute of Clinical Medicine, University of Tsukuba, Ibaraki, Japan. masasato@md.tsukuba.ac.jp
Sakata
Chiho
C
Yabe
Mikako
M
Oshika
Tetsuro
T
D000368:Aged; D000369:Aged, 80 and over; D002387:Cataract Extraction / Q000379:methods*; D002452:Cell Count; D002807:Chondroitin / Q000627:therapeutic use*; D002809:Chondroitin Sulfates; D019610:Cytoprotection; D004338:Drug Combinations; D004728:Endothelium, Corneal / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000473:pathology; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000627:therapeutic use*; D007429:Intraocular Pressure; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification; D011184:Postoperative Period; D013997:Time Factors; D014463:Ultrasonography
D004338:Drug Combinations; C501944:chondroitin sulfate, sodium hyaluronate drug combination; D006820:Hyaluronic Acid; D002807:Chondroitin; D002809:Chondroitin Sulfates