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[Viscoelastic substances in cataract surgery. Principles and current overview]

V Hessemer1, B Dick

  • 1Augenklinik Justus-Liebig-Universität Giessen.

Klinische Monatsblatter Fur Augenheilkunde
|August 1, 1996
PubMed
Summary

Viscoelastic substances protect the corneal endothelium during cataract surgery by maintaining chamber depth and cushioning against trauma. Different formulations offer varied surgical handling and potential side effects like increased intraocular pressure.

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Area of Science:

  • Ophthalmology
  • Biomaterials Science
  • Surgical Technology

Background:

  • Cataract surgery necessitates protecting the corneal endothelium from mechanical and thermal damage.
  • Viscoelastic substances are crucial for maintaining anterior chamber integrity and providing a protective barrier.
  • Sodium hyaluronate (NaHA) and hydroxypropylmethylcellulose (HPMC) are common viscoelastic agents used in ophthalmic procedures.

Purpose of the Study:

  • To review the role and efficacy of viscoelastic substances in preventing corneal endothelial cell loss during cataract surgery.
  • To compare the properties and surgical behavior of various viscoelastic agents, including different concentrations and formulations of NaHA and HPMC.
  • To discuss the rheological properties, surgical handling, and potential side effects, such as intraocular pressure (IOP) increase, associated with these substances.

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Main Methods:

  • Literature review of studies on viscoelastic substances in cataract surgery.
  • Analysis of rheological properties (viscoelasticity, viscosity, pseudoplasticity) of different agents.
  • Evaluation of surgical behavior (injectability, aspiration, manipulation) and side effects (IOP).

Main Results:

  • Sodium hyaluronate (NaHA) is a well-established viscoelastic agent providing endothelium protection in cataract surgery, particularly phacoemulsification.
  • Newer NaHA formulations, chondroitin sulfate-NaHA mixtures, and HPMC solutions offer varied rheological properties and surgical characteristics.
  • Differences in viscoelasticity, viscosity, and pseudoplasticity influence surgical handling and can lead to side effects like IOP elevation.

Conclusions:

  • Viscoelastic substances are essential for minimizing corneal endothelial cell loss in cataract surgery through mechanical protection and chamber maintenance.
  • The choice of viscoelastic agent impacts surgical ease and outcomes, with varying properties influencing performance and potential complications.
  • Understanding the rheological characteristics and side effects of different viscoelastic substances is vital for optimizing patient safety and surgical success.