Phaco equally safe without the use of viscoelastic, study shows

Faster surgical times and less risk of postoperative IOP spikes are two advantages of forgoing viscoelastic substances, surgeon says.

Phacoemulsification without the use of viscoelastic is a safe and effective procedure, according to a prospective study carried out at a research center in Switzerland.

Bojan Pajic

“Continuous [anterior chamber] irrigation maintains a stable chamber and protects the endothelium from surgically induced damage,” Bojan Pajic, MD, said. “We performed continuous circular capsulorrhexis and then phacoemulsification with the stop-and-chop technique. Finally, we implanted the IOL.”

During the procedure, balanced salt solution was used through the irrigation and aspiration unit, without the use of viscoelastic, Dr. Pajic said.

Less surgical time

One of the advantages of not using viscoelastic is the faster surgical time.

“Cataract surgery can be carried out in 3 minutes,” Dr. Pajic said.

In addition, by eliminating the risk of leaving viscoelastic remnants in the eye, the chance of postoperative IOP spikes is minimized.

A total of 126 patients were enrolled in the study and divided in two groups, in which Healon (sodium hyaluronate, Abbott Medical Optics) and balanced salt solution were used.

Postoperative data showed no significant difference between the groups regarding endothelial cell loss.

The mean endothelial cell loss at 1 month was 106 cells/mm² (4.5%) in the balanced salt solution group and 122 cells/mm² (5.3%) in the sodium hyaluronate group.

Age and cell loss

No significant difference was found regarding cell shape and size. IOP was comparable in the two groups. However, a significant correlation was observed between cell loss and age of the patients in both groups.

This approach has a learning curve, but in expert hands, it is safe and holds several advantages, Dr. Pajic said. — by Michela Cimberle

• Bojan Pajic, MD, can be reached at the Swiss Eye Research Foundation, AZP Augenzentrum Pajic, Reinach, Switzerland; e-mail: bpajic@datacomm.ch.

This study shows that phacoemulsification without the use of viscoelastic is a dream that can indeed come true. In our daily practice, since irrigation is potentially traumatic to the endothelium and viscoelastic is the most effective protection, we currently have to prevent endothelial damage. We must consider if the advantages of not using it really outweigh the disadvantages. However, phaco without visco is an alternative that deserves further consideration, in view of the fast developments of microincision techniques, where the quantity of fluids we introduce in the eye is far less than in standard phaco. I still prefer to be on the safe side and use visco, but I see a lot of potential in this alternative procedure for future applications.

– Alessandro Galan, MD
Head of Sant’Antonio Eye Clinic, Padua, Italy