Efficacy of the soft-shell technique using Viscoat and Hyal-2000.

PURPOSE: To evaluate whether the soft-shell technique using Viscoat (sodium hyaluronate 3%-chondroitin sulfate 4%) and Hyal-2000 (sodium hyaluronate 1%) reduces corneal endothelial cell damage during cataract surgery.

SETTING

Department of Ophthalmology, Kangnam St. Mary's Hospital, Seoul, Korea.

METHODS

The nuclear opacity in 252 eyes of 230 cataract patients was classified as grade 1, 2, 3, or > or =4 using the Lens Opacities Classification System III. In each classification, the patients were divided into 4 groups before phacoemulsification based on the type of ophthalmic viscosurgical device (OVD) used during surgery: Viscoat and Hyal-2000 (soft-shell technique), Viscoat alone, Hyal-2000 alone, or Provisc (sodium hyaluronate 1%) alone. All patients were operated on using the same technique except for the OVD. The visual acuity, corneal endothelial cell density, corneal thickness, and intraocular pressure (IOP) were evaluated postoperatively.

RESULTS

The rate of endothelial cell loss 2 months after surgery in eyes with a nuclear opacity grade of > or =4 was significantly different between the 4 OVD groups. The rate in eyes with a nuclear opacity grade of < or =3 was not significantly different between the groups. There were no statistically significant differences between the 4 groups in visual acuity, corneal thickness, or IOP throughout the follow-up period.

CONCLUSION

The soft-shell technique using Viscoat and Hyal-2000 protected corneal endothelial cells during cataract surgery in patients with a nuclear opacity grade of > or =4.