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Dispersive OVD enhances safety in eyes with intraoperative floppy iris syndrome
The low-weight material significantly reduced endothelial cell loss, use of balanced salt solution and the need for iris retention rings.
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A dispersive ophthalmic viscosurgical device protected the corneal endothelium during cataract surgery in eyes with intraoperative floppy iris syndrome, a study showed.
At the American Society of Cataract and Refractive Surgery meeting in Chicago, Donald R. Nixon, MD, FRCS, presented results obtained by using Healon (sodium hyaluronate, Abbott Medical Optics) ophthalmic viscosurgical device (OVD) with and without Healon EndoCoat 3% sodium hyaluronate in eyes with intraoperative floppy iris syndrome (IFIS) secondary to the use of Flomax (tamsulosin, Boehringer Ingelheim).
The addition of the dispersive Healon EndoCoat to Healon OVD in cases of IFIS was associated with lower endothelial cell loss, lower balanced salt solution consumption and reduced usage of an iris retention device, Nixon said.
“I would recommend you use a combination viscoelastic dispersive-cohesive, in this case Healon with Healon EndoCoat, not only in cases of IFIS, but it is also very useful in cases of trauma, Fuchs’ endothelial dystrophy as well as pseudoexfoliation,” Nixon said. “I think you’ll find that it’s a new tool that goes along with all of the other tools of the Healon catalog, which will give us the ability to give patients the best and safest surgery possible.”
Donald R. Nixon
Healon EndoCoat is a low-molecular weight dispersive OVD designed to maximize endothelial protection during phacoemulsification.
“It had a great clarity when it was inserted in the field because it is 3% sodium hyaluronate. … It is absolutely clear,” Nixon said.
Healon EndoCoat can be used in combination with any Healon cohesive OVD.
Patients and parameters
The randomized study included 40 eyes that underwent phacoemulsification with the WhiteStar Signature platform (AMO) with Ellips FX transversal ultrasound mode and venturi pump. Phaco settings were customized.
Healon OVD was used alone in 20 eyes and in conjunction with Healon EndoCoat in 20 eyes.
The Pentacam Nucleus Grading System (PNS, Oculus) was used to gauge cataract grade preoperatively. The between-group difference in nucleus grades was not statistically significant.
A non-contact specular microscope was used to evaluate endothelial cell counts 4 weeks preoperatively and 6 weeks postoperatively.
Phaco settings were pre-programmed with phaco power at 0% to 10% in eyes with soft cataracts with a PNS nucleus grade of 1, 5% to 20% in eyes with medium cataracts graded 2 or 3, and 10% to 30% in eyes with hard cataracts graded 4 or 5.
Techniques and results
Surgery was performed with a bent 21-gauge needle through a 2.2-mm incision with a 2.2-mm steel blade, platinum 2.2-mm cartridge and platinum injector.
Nixon said he used an approach he describes as a lasso technique, initially placing Healon in a ring along the face of the trabecular meshwork and then filling the rest of the anterior chamber with Healon EndoCoat. This facilitated OVD removal at the end of the case when removing the Healon.
“Due to its cohesive nature, it pulled out residual lens fragments as well as the dispersive OVD at the interface almost like a lasso,” Nixon said.
By clearing all the OVD at the end of the case, this method may be responsible for the lack of an IOP differential between the two groups at 4 hours postoperatively, Nixon said.
The study results also showed that mean endothelial cell loss was about 3% in eyes with EndoCoat and more than 9% in eyes without EndoCoat; the between-group difference was statistically significant (P < .001).
Average use of balanced salt solution was significantly lower in the EndoCoat group (P < .001).
Finally, Malyugin iris retention rings were used in three patients in the EndoCoat group and seven patients in the Healon-only group; the between-group difference was statistically significant. – by Matt Hasson