Viscoelastic protection from endothelial damage by air bubbles
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Updated: Oct 1, 2026

On-Chip Endothelial Inflammatory Phenotyping
Published on: July 21, 2012
Eung Kweon Kim1, Stephen M Cristol, Shin J Kang
1Institute of Vision Research, Department of Ophthalmology,Yonsei University, Seoul, South Korea. eungkkim@yumc.yonsei.ac.kr
Purpose:
To determine whether viscoelastic materials effectively protect the corneal endothelium from air bubbles.
Setting:
Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea.
Methods:
Human eye-bank and rabbit eyes had a standardized phacoemulsification procedure with or without viscoelastic material (Healon [sodium hyaluronate 1.0%], Healon GV [sodium hyaluronate 1.4%], or Viscoat [chondroitin sulfate 4.0%-sodium hyaluronate 3.0%]). The integrity of the endothelium was examined after the procedure with F-actin staining and scanning electron microscopy. Rabbit eyes with and without viscoelastic material (Healon or Viscoat) had a standardized irrigation/aspiration (I/A) procedure. The mucinous layer of the endothelium was examined after the procedure with transmission electron microscopy.
Results:
In the phacoemulsification experiment without viscoelastic material, with Healon, and with Healon GV, the endothelium of human and rabbit corneas had many areas of cell loss in a pattern consistent with air-bubble damage. With Viscoat, endothelial cells remained intact. In the I/A experiment, the mucinous layer of Viscoat-exposed rabbit endothelium appeared thinner. In the same experiments without viscoelastic material or with Healon, the mucinous layer of the endothelium appeared normal.
Conclusions:
Viscoat effectively protected the endothelium from air-bubble damage. Viscoat appears to protect the endothelium by acting as a physical barrier. Its adherence is probably related to the way it interacts with the mucinous layer of the endothelium.
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