Comparison of Corneal Endothelial Parameters and Intraocular Pressure Alterations After Uneventful Cataract Surgery with 1.8% and 3% Sodium Hyaluronate

Year 2024, Volume: 14 Issue: 1, 87 - 93, 30.04.2024

Emre Aydın Hasan Akgöz Mehmet Gökhan Aslan

Abstract

Aim: To assess the effectiveness and safety of two recently developed sodium hyaluronate (Na-Hy) items, differentiated by concentrations of 1.8% and 3%.
Material and Method: Fifty-nine uneventful phacoemulsification cataract surgeries were retrospectively evaluated. Patients were separated into two groups according to the ocular viscoelastic device (OVD) used in the capsulorhexis and phacoemulsification steps of the surgery. There were 30 patients in the 3% Na-Hy group and 29 patients in the 1.8% Na-Hy group. Patients were evaluated regarding endothelial changes by specular microscopy and postoperative intraocular pressure (IOP) alterations. Patients with systemic diseases, intraoperative complications, or mature cataracts were excluded.
Results: The two groups had no significant difference in demographic characteristics. Mean phaco time was 10.8±3.58 seconds in the 3% Na-Hy group and 10.55±3.85 seconds in the 1.8% Na- Hy group. The preoperative, postoperative 1st, and 3rd months endothelial cell density (ECD) measurements were 2525.8±219.7, 2304.7±197.6 and 2230.6±208.8 cells/mm2 in the 3% Na-Hy group, and 2549.7±222.4, 2256.6±198.4 and 2166.3±201.5 cells/ mm2 in the 1.8% Na-Hy group, respectively. The preoperative, postoperative 1st day and 1st week IOP measurements were 17.1±2.56, 20.5±3.82 and 15.76±2.19 in 3% Na-Hy group and 15.96±2.56, 18.1±3.35 and 14.93±2.15 in 1.8% Na-Hy group, respectively. The reduction in endothelial cell density was notably greater in the group treated with 1.8% Na-Hy. At the same time, no significant differences were observed among the groups regarding changes in postoperative intraocular pressure (IOP).
Conclusion: Both Na-Hy products seem safe and effective for routine cataract cases. The 3% Na-Hy showed a better performance for corneal endothelium protection while causing minimal IOP elevation.

Keywords

Hyotek, ocular viscoelastic device, phacoemulsification, sodiumhyaluronate

References

• 1. West ES, Behrens A, McDonnell PJ, Tielsch JM, Schein OD. T he incidence of endophthalmitis after cataract surgery among the U. S. Medicare population increased between 1994 and 2001. Ophthalmology. 2005;112(8):1388–1394.
• 2. Chan E, Mahroo OAR, Spalton DJ. Complications of cataract surgery. Clin Exp Optom. 2010;93(6):379–389.
• 3. Grewal DS, Schultz T, Basti S, Dick HB. Femtosecond laserassisted cataract surgery--current status and future directions. Surv Ophthalmol. 2016;61(2):103–131.
• 4. Linebarger EJ, Hardten DR, Shah GK, Lindstrom RL. Phacoemulsification and modern cataract surgery. Surv Ophthalmol. 1999;44(2):123–147.
• 5. Maár N, Graebe A, Schild G, Stur M, Amon M. Influence of viscoelastic substances used in cataract surgery on corneal metabolism and endothelial morphology: comparison of Healon and Viscoat. J Cataract Refract Surg. 2001;27(11):1756–1761.
• 6. Slabaugh MA, Bojikian KD, Moore DB, Chen PP. Risk factors for acute postoperative intraocular pressure elevation after phacoemulsification in glaucoma patients. J Cataract Refract Surg. 2014;40(4):538–544.
• 7. Malvankar-Mehta MS, Fu A, Subramanian Y, Hutnik C. Impact of Ophthalmic Viscosurgical Devices in Cataract Surgery. J Ophthalmol. 2020;2020.
• 8. Kretz FTA, Limberger IJ, Auffarth GU. Corneal endothelial cell coating during phacoemulsification using a new dispersive hyaluronic acid ophthalmic viscosurgical device. J Cataract Refract Surg. 2014;40(11):1879–1884.
• 9. Holzer MP, Tetz MR, Auffarth GU, Welt R, Völcker HE. Effect of Healon5 and 4 other viscoelastic substances on intraocular pressure and endothelium after cataract surgery. J Cataract Refract Surg. 2001;27(2):213–218.
• 10. Kösekahya P, Atılgan CÜ, Atılgan KG, Koç M, Tekin K, Çağlayan M, et al. Corneal Endothelial Morphology and Thickness Changes in Patients with Gout. Turkish J Ophthalmol. 2019;49(4):178–182.
• 11. Tandon R, Gupta N, Kalaivani M, Sharma N, Titiyal JS, Vajpayee RB. Amniotic membrane transplantation as an adjunct to medical therapy in acute ocular burns. Br J Ophthalmol. 2011;95(2):199–204.
• 12. Goles N, Nerancic M, Konjik S, Pajic-Eggspuehler B, Pajic B, Cvejic Z. Phacoemulsification and IOL-Implantation without Using Viscoelastics: Combined Modeling of Thermo Fluid Dynamics, Clinical Outcomes, and Endothelial Cell Density. Sensors (Basel) . 2021;21(7).
• 13. Poyer JF, Chan KY, Arshinoff SA. New method to measure the retention of viscoelastic agents on a rabbit corneal endothelial cell line after irrigation and aspiration. J Cataract Refract Surg. 1998;24(1):84–90.
• 14. Ventura AC, Wälti R, Böhnke M. Corneal thickness and endothelial density before and after cataract surgery. Br J Ophthalmol. 2001;85(1):18–20.
• 15. Fang EN, Kass MA. Increased intraocular pressure after cataract surgery. Semin Ophthalmol. 1994;9(4):235–242.
• 16. Arshinoff SA, Albiani DA, Taylor-Laporte J. Intraocular pressure after bilateral cataract surgery using Healon, Healon5, and Healon GV. J Cataract Refract Surg. 2002;28(4):617–625.
• 17. McCulley TJ, Miller NR. Is Cataract Surgery a Risk for Developing Nonarteritic Anterior Ischemic Optic Neuropathy? J Neuroophthalmol. 2021;41(1):119–125.
• 18. Llop SM, Papaliodis GN. Cataract Surgery Complications in Uveitis Patients: A Review Article. Semin Ophthalmol. 2018;33(1):64–69.
• 19. Miyauchi S, Iwata S. Evaluations on the usefulness of viscous agents in anterior segment surgery. II. Effect on intraocular pressure and clearance from the anterior chamber. J Ocul Pharmacol. 1989;5(3):221–232.
• 20. Perone JM, Boiche M, Lhuillier L, Ameloot F, Premy S, Jeancolas AL, et al. Correlation Between Postoperative Central Corneal Thickness and Endothelial Damage After Cataract Surgery by Phacoemulsification. Cornea. 2018;37(5):587–590.
• 21. Cheng H, Mcpherson K, Bron AJ, Kersley J, Elkington AR, Ruben M, et al. Cataract surgery: interim results and complications of a randomised controlled trial. Oxford Cataract Treatment and Evaluation Team (OCTET). Br J Ophthalmol. 1986;70(6):402.
• 22. Lundberg B, Jonsson M, Behndig A. Postoperative corneal swelling correlates strongly to corneal endothelial cell loss after phacoemulsification cataract surgery. Am J Ophthalmol. 2005;139(6).
• 23. Rao GN, Waldron WR, Aquavella J V. Morphology of graft endothelium and donor age. Br J Ophthalmol. 1980;64(7):523527.
• 24. Matsuda M, Suda TI, Manabe R. Serial alterations in endothelial cell shape and pattern after intraocular surgery. Am J Ophthalmol. 1984;98(3):313–319.
• 25. Ravalico G, Tognetto D, Baccara F, Lovisato A. Corneal endothelial protection by different viscoelastics during phacoemulsification. J Cataract Refract Surg. 1997;23(3):433439.
• 26. Kiss B, Findl O, Menapace R, Petternel V, Wirtitsch M, Lorang T, et al. Corneal endothelial cell protection with a dispersive viscoelastic material and an irrigating solution during phacoemulsification: Low-cost versus expensive combination. J Cataract Refract Surg. 2003;29(4):733–740.
• 27. Tomomi H, Kazuhisa S. Use of viscoelastic substance in ophthalmic surgery - focus on sodium hyaluronate. Clin Ophthalmol. 2008;2(1):21