Corneal endothelial and intraocular pressure changes after phacoemulsification with Amvisc Plus and Viscoat

Abstract

A prospective, randomized, observer-marked study was conducted to compare corneal endothelial and intraocular pressure (IOP) changes after cataract surgery with the viscoelastic agents Amvisc Plus and Viscoat. Forty-nine patients (50 eyes) who had uncomplicated phacoemulsification and implantation of a posterior chamber intraocular lens were randomly assigned to either Amvisc Plus (25 eyes) or Viscoat (25 eyes) groups. Surgical technique was rigidly standardized in all cases. No significant difference in endothelial parameters or postoperative IOPs measured at 24 hours, one week, and two months was detected by analysis of variance between the Amvisc Plus and the Viscoat groups. Visualization was difficult with Viscoat because of its tendency to retain bubbles. Phacoemulsification energy was related to a loss of endothelial density, regardless of the viscoelastic used. The postoperative beta blocker may have contributed to the lower average postoperative IOP than has been reported.

Effect of antiglaucoma agents on postoperative intraocular pressure after cataract surgery with Viscoat

“…Its effect on postoperative IOP after phacoemulsification is well documented, 7,8 and it has been shown to induce greater increases in IOP than other OVDs. 7,[9][10][11] Various ocular hypotensive agents 12-16 and intracameral cholinergic agents 17,18 have been used to…”

“…These devices can cause increases in IOP; however, the mechanisms responsible for these increases have yet to be elucidated. 6,7,[9][10][11] A major reason for postoperative increases in the IOP appears to be the amount of OVD remaining at the end of surgery. Ophthalmic viscosurgical devices can contribute to obstruction of the aqueous outflow.…”

“…Its effect on postoperative IOP after phacoemulsification is well documented, 7,8 and it has been shown to induce greater increases in IOP than other OVDs. 7,[9][10][11] Various ocular hypotensive agents [12][13][14][15][16] and intracameral cholinergic agents 17,18 have been used to prevent IOP increases after phacoemulsification surgery in which various OVDs are used. However, only 1 study evaluated IOP changes after phacoemulsification surgery using only Viscoat.…”

Simultaneous surgeon and side-view video analysis comparing in situ fracture and stop-and-chop phacoemulsification

“…16 It has been demonstrated that increased phacoemulsification ultrasonic energy expenditure, defined by machine-measured phacoemulsification time and mean percentage of maximum power, is associated with increased corneal ECD loss. 14,17,[22][23][24][25] Endothelial cell density loss is reported to be 4% to 12% with divide-and-conquer techniques 4,7,16,17,26,27 and lower with stop-and-chop methods. 4 Regardless of technique, the location of the phacoemulsification process is important.…”

Ultrasonic power reduction during phacoemulsification using adjunctive NeoSoniX technology

“…37 It has been demonstrated that increased phacoemulsification energy expenditure is associated with increased corneal ECD loss. 11,28,31,[38][39][40] Because of this, techniques and technology have evolved together with the intent to use less ultrasonic energy during phacoemulsification. Ultrasonic energy reductions have been achieved in 4 ways: (1) tip design [17][18][19]21 (Kelman phacoemulsification tip, personal 42 and NeoSoniX-generated tip rotations (Alcon Legacy 20000, Alcon Infinity); and (4) pulsed water jet technology (Aqualase, Alcon Infinity).…”