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

Abstract

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 ≥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 ≥4 was significantly different between the 4 OVD groups. The rate in eyes with a nuclear opacity grade of ≤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 ≥4.