INTRAOCULAR PRESSURE AFTER PHACOEMULSIFICATION USING HYDROXYPROPYL METHYLCELLULOSE AND SODIUM HYALURONATE AS VISCOELASTICS

Authors

  • Muhammad Waseem
  • Naeem Rustam
  • Qamar ul Islam

Abstract

Background: Phacoemulsification and intraocular lens (IOL) implantation has resulted in earlyvisual rehabilitation, increased wound stability and improved refractive results. Viscoelasticsubstances (VES) are important adjuncts in this type of surgery. Use of VES inphacoemulsification can be associated with adverse effects, the most common and potentiallydangerous of which is the transient rise in intraocular pressure (IOP) in post-operative period. Toevaluate the effects of viscoelastic substances on post-operative IOP after phacoemuls ificationwith implantation of intraocular lens, a cross-sectional comparative, prospective study wasconducted in the department of Ophthalmology, Combined Military Hospital, Peshawar, Pakistan,from October 2003 to March 2004. Methods: One hundred patients were randomized into twogroups of 50 each. Phacoemulsification with implantation of intraocular lens was performed in allthe patients. 2% Hydroxypropyl Methylcellulose (HPMC) was used in one group and 1% SodiumHyaluronate (NaHa) was used in the other group. IOP was measured pre-operatively as well as 24hours and 7 days post-operatively. Results: There was no significant difference in the preoperative intraocular pressure between the two groups (p=0.483). Twenty four hours after surgery,the mean IOP increased by 2.84±SD 2.12 mm Hg in 2% Hydroxypropyl Methylcellulose groupand 4.54±2.07 mm Hg in 1% Sodium Hyaluronate group. The increase was significantly higher in1% Sodium Hyaluronate group as compared to 2% Hydroxypropyl Methylcellulose group(p=0.003). Seven days after surgery the mean intraocular pressure returned to near pre-operativelevels in both the groups. Conclusion: Sodium Hyaluronate causes significantly higher increasein intraocular pressure in early post-operative period after cataract surgery inspite of maximumaspiration of viscoelastic substance from the eye following phacoemulsification surgery.Key Words: Intraocular pressure, Methylcellulose, Sodium Hyaluronate, Phacoemulsification,Viscoelastic substance.

References

Tarin SA. Viscoelastic substances: properties and uses in

anterior segment surgery. Pakistan J Ophthalmol.

;12(1):22-6.

Madhavan HN, Roy S. Effects of viscoelastic ophthalmic

solutions on cell cultures. Indian J Ophthalmol.

;46(1):37-40.

Maar 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.

;27(11):1756-61.

Arshinoff SA. Dispersive-cohesive viscoelastic soft shell

technique. J Cataract Refract Surg. 1999;25(2):167-73.

Arshinoff SA, Albiani DA, Laporte JT. Intraocular pressure

after bilateral cataract surgery using Healon, Healon 5, and

Healon GV. J Cataract Refract Surg 2002;28(4):617-25

Rainer G, Menapace R, Findl O, Kiss B, Petternel V,

Georgopoulos M, et al. Intraocular pressure rise after small

incision cataract surgery: a randomized intraindividual

comparison of two dispersive viscoelastic agents. Br J

Ophthalmol 2001;85(2):139-42.

Jone DT, Karp CL, Heigle TJ. Principles and techniques of

cataract surgery phacoemulsification: Methodology and

complications. In: Albert DM, Robinson NL, Barney NP,

Brightbill FS, Clayman HM, Kaufman PL, et al, eds.

Ophthalmic surgery: Principles and techniques. USA:

Blackwell Science, Inc; 1999: 283-312.

Mckellar MJ, Elder MJ. The early complications of cataract

surgery: is routine review of patients 1 week after cataract

extraction necessary?

Ophthalmology. 2001 May;108(5):930-5.

Morgan RK, Sk uta GL. Viscoelastic-related glaucomas.

Semin Ophthalmol. 1994; 9(4):229-34.

Harooni M, Freilich JM, Abelson M, Refojo M. Efficacy of

hyaluronidase in reducing increases in intraocular pressure

related to the use of viscoelastic substances. Arch Ophthalmol.

;116(9):1218-21

Rainer G, Menapace R, Findl O, Georgopoulos M, Kiss B,

Petternel V. Intraocular pressure after small incision cataract

surgery with Healon 5 and Viscoat. J Cataract Refract Surg.

; 26(2):271-6.

Ahmed II, Kranemann C, Chipman M, Malam F. Revisiting

early postoperative follow-up after phacoemulsification. J

Cataract Refract Surg. 2002;28(1):100-8.

Luchtenberg M, Luchtenberg C, Lang M, Badachschi N ,

Emmerich KH. Intraocular pressure response after

administration of 3 different viscoelastic agents after cataract

operation. Ophthalmologe. 2000;97(5):331-5

Jürgens I, Matheu A, Castilla M . Ocular hypertension after

cataract surgery: a comparison of three surgical techniques

and two viscoelastics. Ophthalmic Surg Lasers.

;28(1):30-6

Holzer MP, Tetz MR, Auffarth GU, Welt R, Völcker HE.

Effect of Healon 5 and 4 other viscoelastic substances on

intraocular pressure and endothelium after cataract surgery. J

Cataract Refract Surg. 2001;27(2):213-8.

Kohnen T, von Ehr M, Schütte E, Koch DD. Evaluation of

intraocular pressure with Healon and Healon GV in sutureless

cataract surgery with foldable lens implantation. J Cataract

Refract Surg 1996; 22(2):227-37

Hazariwala K, Mortimer CB, Slomovic AR. Comparison of

% Hydroxypropyl methylcellulose and 1% Sodium

hyaluronate in implant surgery. Can J Ophthalmol 1988;

(6):259-61.

Mac Rae SM, Edelhauser HF, Hyndiuk RA, Burd EM, Schultz

RO. The effects of Sodium Hyaluronate, Chondroitin sulfate,

and Methylcellulose on the corneal endothelium and

intraocular pressure. Am J Ophthalmol. 1983; 95(3): 332-41

Liesegang TJ, Bourne WM, Ilstrup DM. The use of

hydroxypropyl methylcellulose in extracapsular cataract

extraction with intraocular lens implantation. Am J

Ophthalmol. 1986; 102(6):723-6.

Junejo SA, Laghari NA. Analysis of short -term effect of two

viscoelastic agents on intraocular pressure after extracapsular

cataract extraction and posterior chamber lens implantation.

Pakistan J Ophthalmol 1996; 12(2):64-5.

Junejo SA, Khan SA. Incidence of glaucoma in

pseudoaphakia and its management. J Coll Physicians Surg

Pak. 1996; 6:309-12.

Wedrich A, Menapace R. Intraocular pressure following

small-incision cataract surgery and poly HEMA posterior

chamber lens implantation. A comparison between

acetylcholine and carbachol. J Cataract Refract Surg 1992;

(5):500-5.

Jacobi PC, Engels B, Dietlein TS, Krieglstein GK. Effect of

trabecular aspiration on early intraocular pressure rise after

cataract surgery. J Cataract Refract Surg. 1997; 23(6):923-9.

Downloads

Published

2007-03-01