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Changes in corneal endothelium cell characteristics after cataract surgery with and without use of viscoelastic substances during intraocular lens implantation.

Schulze SD, Bertelmann T, Manojlovic I, Bodanowitz S, Irle S, Sekundo W - Clin Ophthalmol (2015)

Bottom Line: After 1 and 6 weeks, ECD decreased and endothelium cell size increased significantly in both groups (each P<0.001) without significant differences between both groups (each P>0.05).Irrigation-aspiration suction time (30.3±16.6 versus 36.3±14.5 seconds) and overall surgical time (7.2±1.2 versus 8.0±1.4 minutes) were significantly longer in the OVD Z-Celcoat group (each P<0.001).No complications or serious side effects occurred.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Philipps University of Marburg, Marburg, Germany.

ABSTRACT

Purpose: To evaluate whether the use of balanced salt solution (BSS) or an ophthalmic viscoelastic device (OVD) during hydrophilic acrylic intraocular lens (IOL) implantation variously impacts corneal endothelial cell characteristics in eyes undergoing uneventful phacoemulsifications.

Methods: Prospective nonrandomized observational clinical trial. Patients were assigned either to the BSS plus(®) or to the OVD Z-Celcoat™ group depending on the substance used during IOL implantation. Corneal endothelium cell characteristics were obtained before, 1 week, and 6 weeks after surgery. Intraoperative parameters (eg, surgery time, phacoemulsification energy) were recorded.

Results: Ninety-seven eyes were assigned to the BSS plus and 86 eyes to the Z-Celcoat group. Preoperative corneal endothelium cell density (ECD) and endothelium cell size were 2,506±310 cells/mm(2)/2,433±261 cells/mm(2) and 406±47 µm(2)/416±50 µm(2) (P=0.107/P=0.09). After 1 and 6 weeks, ECD decreased and endothelium cell size increased significantly in both groups (each P<0.001) without significant differences between both groups (each P>0.05). Irrigation-aspiration suction time (30.3±16.6 versus 36.3±14.5 seconds) and overall surgical time (7.2±1.2 versus 8.0±1.4 minutes) were significantly longer in the OVD Z-Celcoat group (each P<0.001). No complications or serious side effects occurred.

Conclusion: Implantation of a hydrophilic acrylic IOL under BSS infusion seems to be a useful and faster alternative in experienced hands without generating higher ECD loss rates.

No MeSH data available.


Comparison of endothelium cell density in both groups.Note: BSS plus® group (blue); Z-Celcoat™ group (yellow).Abbreviation: ECD, endothelium cell density.
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f1-opth-9-2073: Comparison of endothelium cell density in both groups.Note: BSS plus® group (blue); Z-Celcoat™ group (yellow).Abbreviation: ECD, endothelium cell density.

Mentions: With regard to CEC characteristics, the data presented herein show that there are no significant differences in overall ECD between both groups at baseline as well as after 1 and 6 weeks (Figure 1). In contrast, in the BSS plus and Z-Celcoat group, there was a significant CEC loss after 1 and 6 weeks without any significant difference between both groups (Table 3). Overall ECS did not differ significantly between both groups at any time either (Figure 2). ECS in the BSS plus and Z-Celcoat group increased significantly after 1/6 weeks ~7.6%/9.9% and 7.5%/8.7% (Table 3). These results demonstrate that there is a significant CEC loss and a consecutive ECS increase 1 and 6 weeks after an uneventful phacoemulsification irrespective of the fact which fluid/device was used for IOL implantation. This is an interesting observation because these results indicate that there is no additional benefit in the use of OVDs during IOL implantation at least in experienced hands using a single-hand injector (Figure 3) and a hydrophilic acrylic IOL. CEC loss herein matches with results from former investigations where rates between 1.2% and 19.2% in the short and long terms were reported, depending on surgical techniques and different OVDs that were used for IOL implantation.20,23,25–33 A meta-analysis of different OVDs to protect the CEC during phacoemulsifications was recently published and demonstrated that different OVDs show a variable impact on CEC loss but that all substances provided a basic CEC protection because CEC loss with each OVD was <100 cells/mm after 3 months.10 In contrast, comparative studies between BSS only and OVDs are rare. Nayak et al found, similar to the results herein, no difference in CEC loss between a BSS and an OVD group. The setting was different though (no OVD during capsulorhexis, use of a higher viscous OVD). In both groups, postoperative CEC loss was 7.5%.34 Lee et al’s study design has more similarities to our setting, but they compared the high viscosity OVD Amvisc Plus™ (Bausch & Lomb Incorporated, Bridgewater, NJ, USA) with BSS during hydrophilic acrylic IOL implantation and found a decrease of ~3% after 3 months without significant differences between both groups.16


Changes in corneal endothelium cell characteristics after cataract surgery with and without use of viscoelastic substances during intraocular lens implantation.

Schulze SD, Bertelmann T, Manojlovic I, Bodanowitz S, Irle S, Sekundo W - Clin Ophthalmol (2015)

Comparison of endothelium cell density in both groups.Note: BSS plus® group (blue); Z-Celcoat™ group (yellow).Abbreviation: ECD, endothelium cell density.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4644175&req=5

f1-opth-9-2073: Comparison of endothelium cell density in both groups.Note: BSS plus® group (blue); Z-Celcoat™ group (yellow).Abbreviation: ECD, endothelium cell density.
Mentions: With regard to CEC characteristics, the data presented herein show that there are no significant differences in overall ECD between both groups at baseline as well as after 1 and 6 weeks (Figure 1). In contrast, in the BSS plus and Z-Celcoat group, there was a significant CEC loss after 1 and 6 weeks without any significant difference between both groups (Table 3). Overall ECS did not differ significantly between both groups at any time either (Figure 2). ECS in the BSS plus and Z-Celcoat group increased significantly after 1/6 weeks ~7.6%/9.9% and 7.5%/8.7% (Table 3). These results demonstrate that there is a significant CEC loss and a consecutive ECS increase 1 and 6 weeks after an uneventful phacoemulsification irrespective of the fact which fluid/device was used for IOL implantation. This is an interesting observation because these results indicate that there is no additional benefit in the use of OVDs during IOL implantation at least in experienced hands using a single-hand injector (Figure 3) and a hydrophilic acrylic IOL. CEC loss herein matches with results from former investigations where rates between 1.2% and 19.2% in the short and long terms were reported, depending on surgical techniques and different OVDs that were used for IOL implantation.20,23,25–33 A meta-analysis of different OVDs to protect the CEC during phacoemulsifications was recently published and demonstrated that different OVDs show a variable impact on CEC loss but that all substances provided a basic CEC protection because CEC loss with each OVD was <100 cells/mm after 3 months.10 In contrast, comparative studies between BSS only and OVDs are rare. Nayak et al found, similar to the results herein, no difference in CEC loss between a BSS and an OVD group. The setting was different though (no OVD during capsulorhexis, use of a higher viscous OVD). In both groups, postoperative CEC loss was 7.5%.34 Lee et al’s study design has more similarities to our setting, but they compared the high viscosity OVD Amvisc Plus™ (Bausch & Lomb Incorporated, Bridgewater, NJ, USA) with BSS during hydrophilic acrylic IOL implantation and found a decrease of ~3% after 3 months without significant differences between both groups.16

Bottom Line: After 1 and 6 weeks, ECD decreased and endothelium cell size increased significantly in both groups (each P<0.001) without significant differences between both groups (each P>0.05).Irrigation-aspiration suction time (30.3±16.6 versus 36.3±14.5 seconds) and overall surgical time (7.2±1.2 versus 8.0±1.4 minutes) were significantly longer in the OVD Z-Celcoat group (each P<0.001).No complications or serious side effects occurred.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Philipps University of Marburg, Marburg, Germany.

ABSTRACT

Purpose: To evaluate whether the use of balanced salt solution (BSS) or an ophthalmic viscoelastic device (OVD) during hydrophilic acrylic intraocular lens (IOL) implantation variously impacts corneal endothelial cell characteristics in eyes undergoing uneventful phacoemulsifications.

Methods: Prospective nonrandomized observational clinical trial. Patients were assigned either to the BSS plus(®) or to the OVD Z-Celcoat™ group depending on the substance used during IOL implantation. Corneal endothelium cell characteristics were obtained before, 1 week, and 6 weeks after surgery. Intraoperative parameters (eg, surgery time, phacoemulsification energy) were recorded.

Results: Ninety-seven eyes were assigned to the BSS plus and 86 eyes to the Z-Celcoat group. Preoperative corneal endothelium cell density (ECD) and endothelium cell size were 2,506±310 cells/mm(2)/2,433±261 cells/mm(2) and 406±47 µm(2)/416±50 µm(2) (P=0.107/P=0.09). After 1 and 6 weeks, ECD decreased and endothelium cell size increased significantly in both groups (each P<0.001) without significant differences between both groups (each P>0.05). Irrigation-aspiration suction time (30.3±16.6 versus 36.3±14.5 seconds) and overall surgical time (7.2±1.2 versus 8.0±1.4 minutes) were significantly longer in the OVD Z-Celcoat group (each P<0.001). No complications or serious side effects occurred.

Conclusion: Implantation of a hydrophilic acrylic IOL under BSS infusion seems to be a useful and faster alternative in experienced hands without generating higher ECD loss rates.

No MeSH data available.