Comparison of the effect of sodium hyaluronate (Ophthalin®) and hydroxypropylmethylcellulose (HPMC-Ophtal®) on corneal endothelium, central corneal thickness, and intraocular pressure after phacoemulsification
Department of Ophthalmology, Royal Victoria Infirmary, University of Newcastle upon Tyne, Newcastle upon Tyne, United Kingdom. European journal of ophthalmology
(Impact Factor: 1.07).
To prospectively evaluate the effects of 2% hydroxypropyl-methylcellulose (HPMC-Ophtal) and sodium hyaluronate 1% (Ophthalin) on intraocular pressure, corneal thickness, and endothelial cell loss in small incision cataract surgery with implant.
A total of 110 patients undergoing routine phacoemulsification with implant received either 2% hydroxypropyl methylcellulose or sodium hyaluronate 1% as ophthalmic viscosurgical device. Pre- and postoperative slitlamp examination, intraocular pressure measurement (preoperatively and at 1-4 hours, 1 day, and 7 days postoperatively), ultrasonic pachymetry (preoperatively and at 1 week, 4-6 weeks, and 12 weeks post operatively), and corneal endothelial cell count (preoperatively and 12 weeks postoperatively) were performed. Data were analyzed using two-way analysis of variance.
All measurements were comparable between the two groups preoperatively. Intraocular pressure was significantly lower in the Ophthalin group at 1 day post operatively, while no significant difference was found between the two groups on the 1-4 hours and 7 days examination. The central corneal thickness was not significantly different between the two groups at any postoperative visit . However, the mean cell density demonstrated a significant fall of 11.76% for Ophthalin and 4.27% for HPMC-Ophtal at 12 weeks post-operatively, the difference between the two being significant (p=0.009).
2% Hydroxypropyl methylcellulose, compared with sodium hyaluronate 1%, is superior in protecting the corneal endothelial cells, has the same effect on central corneal thickness, and is associated with slightly higher intraocular pressure 1 day post operatively. It compares favorably with sodium hyaluronate 1% and can be used as an effective and cheaper alternative in routine small incision cataract surgery with implant.
Available from: Koray Gumus
- "As a result, it was decided that there was an incompatibility between CH, monosodium phosphate and Carbopol, and thus HPMC, which showed no sign of incompatibility, was chosen for the formulation . Over the past years, many researches have addressed whether HPMC could be used safely for ophthalmic formulations     . "
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ABSTRACT: In the present study, viscous solutions of cysteamine hydrochloride (CH) were prepared by using 0.5%, 1.0%, 1.5% or 3.0% of hydroxypropylmethylcellulose (HPMC) and were evaluated for their in-vitro characteristics and stability. Osmolalities, pH and viscosity of the formulations were determined. The influence of benzalkonium chloride and autoclave sterilization on solution characteristics was also investigated. For stability assessment, the viscous solutions were stored at +4 and +25 °C over 12 months. In-vitro characteristics and CH contents of the stored solutions were monitored. Irritation tests for the formulations were evaluated on rabbit eyes. Dialysis sac technique was used to perform in vitro release study of the solutions containing 1.0% and 1.5% HPMC. All of the viscous solutions tested showed non-newtonian (dilatant) flow behavior. Osmolality values were ranked between 351.2 ± 6.2 and 355.1 ± 7.9 mOsm kg−1, and pH values were between 3.97 ± 0.1 and 3.98 ± 0.2 for all the solutions. Furthermore, no significant changes in dilatant behavior, osmolality or pH values of the pure HPMC solutions were observed. After addition of the excipients or CH-excipients, increased viscosity values were noted in these formulations. Neither benzalkonium chloride nor autoclave sterilization had any influence on viscosity, pH or osmolality values of the solution containing 1.5% HPMC. Stability studies showed that a faster decrease in the concentration of CH was observed in the formulations stored at 25 °C compared to those kept at 4 °C; no changes were determined in osmolality values of the solutions at all storage conditions. Increased pH and decreased viscosity values were noted in HPMC solutions containing CH and excipients, while no changes in these values were observed for pure HPMC solutions kept at 4 and 25 °C. In vitro release tests revealed that 81.2% and 85.3% of CH were released from the viscous solutions containing 1.5% and 1% HPMC, respectively, in 8 h. No irritation was observed when the viscous solutions were tested on rabbit and human eyes.
European Journal of Pharmaceutics and Biopharmaceutics 09/2008; 70(1-70):260-269. DOI:10.1016/j.ejpb.2008.04.010 · 3.38 Impact Factor
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ABSTRACT: The indications for ophthalmic viscosurgical devices have expanded with the introduction of newly developed ophthalmic viscosurgical devices. The characteristics of different ophthalmic viscosurgical devices and their specific uses in anterior segment surgery and possible problems are discussed.
Ophthalmic viscosurgical devices were first introduced to maintain space in the eye during the implantation of intraocular lenses. With the development of different types of ophthalmic viscosurgical devices, additional indications have been discussed. To protect the corneal endothelium, the ability of ophthalmic viscosurgical devices to be retained during phacoemulsification was compared. To enlarge and stabilize the size of the pupil, specific ophthalmic viscosurgical devices are used in patients with small pupils or intraoperative floppy iris syndrome. On the other hand, complications associated with the use of ophthalmic viscosurgical devices and their prevention have been discussed. Postoperative elevations of intraocular pressure have been reported and complete removal of the ophthalmic viscosurgical device at the end of surgery is the key factor to avoiding these elevations. Wound burns during phacoemulsification may occur and creating a fluid space around the phacoemulsification tip is necessary to avoid them.
The rheologic characteristics of the different types of ophthalmic viscosurgical device should be considered, and the appropriate use of ophthalmic viscosurgical devices in specific cases would improve the surgical outcomes.
Current Opinion in Ophthalmology 02/2008; 19(1):50-4. DOI:10.1097/ICU.0b013e3282f14db0 · 2.50 Impact Factor
Available from: Alex J Shortt
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ABSTRACT: To compare ophthalmic viscoelastic devices (OVDs) in protecting the cornea from endothelial cell loss during cataract surgery.
A systematic review yielded 21 randomised controlled trials including 1769 patients. OVDs were classified according to the Arshinoff classification. Traditional pairwise meta-analyses were performed for each direct comparison. Mixed treatments comparisons (MTC) analysis was also performed to combine all direct and indirect comparisons. The outcome measure was loss in endothelial cell density 3 months after surgery.
Direct comparison meta-analysis showed that viscoadaptives lead to a lower loss in cell density compared with very low viscosity dispersives, and compared with super viscous cohesives. The soft shell technique, a combination of viscous cohesives and medium viscosity dispersives, showed a lower loss compared with viscous cohesives, but was not compared with the other treatments. The MTC analysis shows that comparing all treatment options together, all mean differences were ≤ 100 cells/mm(2). The probability of being the best treatment option is 80% for viscoadaptives and 18% for the soft shell technique.
Viscoadaptives may be superior to the other OVDs, but absolute differences in loss in endothelial cell density are <100 cells/mm(2).
The British journal of ophthalmology 12/2009; 95(1):5-10. DOI:10.1136/bjo.2009.158360 · 2.98 Impact Factor
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