Effect of Healon5 and 4 other viscoelastic substances on intraocular pressure and endothelium after cataract surgery

Purpose: To compare the ophthalmic viscoelastic device (OVD) Healon(R)5 (so dium hyaluronate 2.3%) with 4 other commonly used OVDs during phacoemulsifi cation and intraocular lens implantation in terms of influence on intraocul ar pressure (IOP) postoperatively and endothelial cells preoperatively and postoperatively. Setting: Department of Ophthalmology, Ruprecht-Karls-University Heidelberg, Germany. Methods: This clinical randomized prospective study, in which patients and observer were masked, comprised 81 eyes. Seventy-four eyes (man patient age 71.2 years +/- 7.8 [SD]) completed all preoperative and 5 postoperative ex aminations. the OVDs used were OcuCoat(R) and Celoftal(R) (hydroxypropyl me thylcellulose 2.0%), Viscoat(R) (sodium hyaluronate 3.0%-chondroitin sulfat e 4.0%), Healon GV(R) (sodium hyaluronate 1.4%), and Healon5 (sodium hyalur onate 2.3%). Intraocular pressure was measured by standard Goldmann applana tion tonometry preoperatively and 4 to 6 and 24 hours and 7, 30, and 90 day s postoperatively. Endothelial cell counts were done preoperatively and 90 days postoperatively using a Pro/Koester WFSCM contact endothelial microsco pe. Exclusion criteria were IOP greater than 21 mm Hg at the preoperative e xamination, age younger than 40 years, significant corneal pathology, and a history or presence of uveitis or pseudoexfoliation syndrome. Results: All groups had increased IOP 4 hours postoperatively. The Healon5 group had the highest mean pressure (24.9 mm Hg) followed by the Viscoat gr oup (23.6 mm Hg). The mean IOP in the other OVD groups was less than 22.1 m m Hg. These differences were not significant. Twenty-four hours postoperati vely and at ail subsequent examinations, mean IOP was below 20 mm Hg. The H ealon5 group had the lowest mean endothelial cell loss (6.2%), significantl y lower than in the other groups (P < .02). Conclusion: With all 5 OVDs, endothelial cell loss was found, with the lowe st in the Healon5 group, and IOP was increased 4 to 6 hours postoperatively . After 24 hours, no significant increases in IOP were noted. J Cataract Re fract Surg 2001; 27: 213-218 (C) 2001 ASCRS and ESCRS.