Comparative study on application of DisCoVisc ophthalmic viscosurgical device and sodium hyaluronate in phacoemulsification

Abstract

Background Ophthalmic viscosurgical device plays an important supporting role in cataract surgery. Pure sodium hyaluronate product is currently widely used in China. In recent years, the advent of a new generation of viscoelastics DisCoVisc provides a new choice in cataract surgery, but whether its efficacy is better than sodium hyaluronate is still unclear. Objective This study was to compare the efficacy and safety between DisCoVisc and sodium hyaluronate in phacoemulsification. Methods One hundred and forty-three eyes of 118 patients with age-related cataract were enrolled in Xiangya Hospital from May 2012 to May 2013, including soft nuclear cataract (II – III grade) 78 eyes of 67 patients and hard nuclear cataract (≥Ⅳ grade) 65 eyes of 51 patiens according to Emery-Little classification criteria, and then the patients were assigned to the DisCoVisc group and the sodium hyaluronate group, respectively, based on random number table. A combined procedure of phacoemulsification with foldable intraocular lenses was performed on all the patients and DisCoVisc and sodium hyaluronate were used during the surgery, respectively under the informed consent of each patient. The intraoperative parameters including ultrasound time (UST), cumulative dissipated energy (CDE) and removing time of DisCoVisc or sodium hyaluronate were recorded. The visual acuity, intraocular pressure (IOP), eyes of corneal edema, central corneal thickness (CCT) and corneal endothelial cell density were evaluated and compared during the follow-up duration of 3 months. Results There was no statistically significant differences in UST, CDE, washout time of viscosurgical device and postoperative IOP between the two groups in both soft and hard nuclear cataract eyes (all at P>0.05). In the eyes with soft nuclear cataract, there was no significant differences in visual acuity, corneal edema, CCT and the rate of corneal endothelial cell loss throughout the follow-up period between the two groups (all at P>0.05). In patients with hard nuclear cataract, the proportions of eyes with uncorrected visual acuity≥0.5 and corneal edema were 72.7% and 18.2% at 1 day after surgery in the DisCoVisc group and 46.9% and 43.8% in the sodium hyaluronate group, showing significant differences between them (χ2=4.524, P=0.033; X2=4.986, P=0.026); The CCT at 1 day after surgery was (576.60±39.05) μm in the DisCoVisc group and (597.82±44.25) μm in the sodium hyaluronate group, with a significant difference between the two groups (t=2.124, P=0.038); The rate of corneal endothelial cell loss 3 months after surgery was (12.56±5.46) % in the DisCoVisc group, which was significantly lower than (19.61±6.79)% in the sodium hyaluronate group (t=3.131, P=0.004). Conclusions DisCoVisc is safe and effective for the cataract surgery. For the patients with hard nuclear cataract, DisCoVisc appears to have better outcomes and less complications than sodium hyaluronate in early stage after operation. Key words: Cataract/surgery; Phacoemulsification; Viscoelastic/efficacy and safety; Comparative study