Intraocular Irrigating Solutions Research Articles

Compound electrolyte intraocular irrigating solution produces better effects on vision recovery of cataract patients after surgery than Ringer lactate solution.

Intraocular irrigating solution is extensively applied in cataract surgery. This paper explored the difference and relationship between optical coherence tomography (OCT) and optical quality analysis system (OQAS) parameters induced by compound electrolyte intraocular irrigating solution (CEIIS) or Ringer lactate (RL) solution during uncomplicated cataract surgery. Totally 200 senior cataract patients were randomly divided into the CEIIS and RL groups (N = 100 patients/group). The anterior chamber was irrigated by CEIIS or RL during phacoemulsification. Patients were subdivided into diabetes mellitus (DM)+ and DM- groups. The central macular thickness (CMT), hyper reflective foci (HF), modulation transfer function cutoff frequency (MTF cutoff), Strehl ratio (SR), objective scatter index (OSI), and OQAS values (OVs) at 100%, 20%, and 9% contrast levels were measured preoperatively and 1day and 1week after operation using spectral-domain optical coherence tomography and OQAS II, respectively. Best-corrected visual acuity (BCVA) was assessed using the Snellen scale, followed by statistical analysis of its logarithm of the minimal angle of resolution. There were no significant differences in clinical characteristics between the CEIIS and RL groups. Both groups exhibited notably increased postoperative CMT, MTF cutoff, SR, OV at 100%, 20%, and 9% contrast levels, and reduced OSI, indicating CEIIS and RL improved postoperative visual quality. CEIIS surpassed RL solution in improving postoperative visual quality, decelerating the increase of macular HF numbers and CMT in DM+ patients and postoperative BCVA. There was no difference between CEIIS and RL in long-term vision improvement. CEIIS surpasses RL in postoperative visual recovery and retards increases of macular HF numbers and CMT in senior DM+ cataract patients.

Development of an anti-oxidative intraocular irrigating solution based on reactive persulfides

Anti-oxidative intraocular irrigating solutions (IISs) based on reactive persulfides, such as oxidized glutathione disulfide (GSSG), are commonly used worldwide. However, even with GSSG-based IISs, it has been shown that oxidative stress can occur during surgery, posing a risk to intraocular tissues. This study compared two IISs: one containing GSSG and one containing an oxidized glutathione trisulfide (GSSSG). Experimental in vivo irrigation with the IISs in rabbits showed that there was less leakage into the anterior chamber of rabbit serum albumin during perfusion with a 300-μM GSSSG IIS than with a 300-μM GSSG IIS. Experimental in vivo cataract surgery in rabbits showed that aqueous flare was suppressed 3 days after surgery with a 600-μM GSSSG IIS, but not with a 300-μM GSSSG or 300-μM GSSG IIS. Furthermore, an in vitro experiment, without any live tissue, showed that reactive oxygen species were suppressed more strongly with a 600-μM GSSSG IIS than with a 300-μM GSSG IIS. Thus, this study found that novel IISs based on GSSSG had anti-inflammatory and anti-oxidative effects during and after intraocular surgery and may decrease the rate of complications after surgery.

Utility of Liquid-Based Cytology and Cell Block Procedure Obtained by Vitrectomy to Diagnose Ocular Sarcoidosis-The Significance of Epithelioid Granuloma and Epithelioid Cells.

PurposeThe eyes are one of the most frequently involved organs in sarcoidosis in Asia, including Japan. Sarcoid uveitis is the major complaint of ocular sarcoidosis. The detection of epithelioid granuloma (EG) requires histological biopsy of the uvea for the precise diagnosis of sarcoid uveitis, because it is challenging to diagnose sarcoid uveitis without a history of systemic sarcoidosis. To diagnose sarcoid uveitis, we have established novel methods.Patients and MethodsIn this study, we included 30 eyes of 21 patients with granulomatous uveitis diagnosed via slit-lamp examinations, gonioscopy, fundus photography, and fluorescein angiography. Vitrectomy was performed to remove the vitreous opacity with vision loss. To examine vitreous cell components, we used liquid-based cytology (LBC). To detect EG in an intraocular irrigating solution, we collected vitreous cell components, and then the cell pellets were embedded in the cell block procedure.ResultsHere, we demonstrated the usefulness of the histological detection of EG and epithelioid cells (ECs) in LBC from vitreous body specimens and in the cell block procedure from vitreous cell components in an intraocular irrigating solution. Our results showed that the detection rates of EG were 6.3% (1/16) in LBC and 9.1% (1/11) in the cell block procedure in the sarcoid uveitis-suspected group and 7.7% (1/13) in LBC and 28.6% (2/7) in the cell block procedure in the sarcoidosis group. We would discuss the specificity of the EG/EC detection of ocular sarcoidosis.ConclusionOur methods are helpful in the precise diagnosis of ocular sarcoidosis and the control of the development of systemic sarcoidosis.

The eye wash technique: A simple and effective technique for intraoperative ocular surface lavage

Objectives: The author proposes an extremely effective and practical method of ocular surface hydrating and cleaning during anterior segment surgery, the Eye Wash Technique (EWT), in substitution for the traditional methods employing a syringe and cannula for ocular irrigation. Materials and Methods: The EWT utilizes the intraocular irrigating solution (IS) used in the surgery. It is performed by employing the irrigating line of the phacoemulsification (phaco) machine or the irrigating fluid IV drip in case of manual cataract surgery. The eye irrigation is performed directly from the Luer end attachment of these irrigating lines, which is positioned above the inner cantus pointing to the globe’s nasal limbal region. With the phaco machine pedal in position 1 (irrigation only) or in panel continuous irrigation mode in case of phaco surgery, or by opening the roller clamp of the IV drip line in case of manual surgery, IS flow ensues and is directed to the eye from a nasal direction to provide a steady flow to wash the exposed eye surface as well as the lid margins and lid speculum. The irrigation is maintained for two to five seconds with side-to-side jiggling if needed, to ensure complete ocular surface coverage. Cornea hydration is achieved and any unwanted material on the ocular surface is washed out. Results: The EWT was easily incorporated into the surgical routine with no difficulty in adaptation to the technique or in its employment. The surgical time was not prolonged when employing the technique. The EWT effectively provided both corneal hydration and ocular surface cleaning every time it was used, with no need to resort to the traditional syringe and cannula irrigation method at any time. Conclusion: The EWT should be incorporated into the anterior segment surgical routine and performed at the beginning of surgery, before inserting the intraocular lens, and at the end of the surgery; also, at any time during surgery should the need arise, enhancing anterior segment surgical visualization and safety.

Delineation of the bacterial composition in exogenous endophthalmitis using 16S rDNA sequencing.

To determine the bacterial spectrum of exogenous endophthalmitis of different origins, namely, posttraumatic, postcataract surgery, filtering bleb-associated, and intravitreal treatment-related endophthalmitis, using the 16S rDNA sequencing method. Aqueous humor or vitreous humor samples were collected from 24 endophthalmitis patients. Traditional cultivation and 16S rDNA sequencing were conducted with these samples. Three senile cataract controls and one intraocular irrigating solution were used as sequencing control. Eleven of the 24 samples (45.8%) obtained positive bacterial cultivation, and each sample positive for only one species. The 11 culture-positive species could all be identified in their corresponding sequencing results, but only four strains being the top one pathogen in the sequencing. A total of 567 species were isolated using 16S rDNA sequencing, with the top five species being Pseudomonas sp., Staphylococcus epidermidis, Staphylococcus sp., Streptococcus sp., and Enterococcus faecalis. The dominant bacterial strains varied among the different endophthalmitis categories but with no significant difference in the overall bacterial spectrum. Bacterial atlas containing Pseudomonas, Streptococcus, Staphylococcus, Actinomycetales_unclassified, Thermus, and Janibacter was shared by the four categories. Aqueous humor bacterial profile showed a higher overlap with contaminating bacteria from the environment. 16S rDNA sequencing is more efficient for endophthalmitis pathogen screening than the traditional cultivation method in terms of positive detection rate and the number of bacteria identified. But the risk of environmental contamination exists when using 16S rDNA sequencing method for endophthalmitis diagnosis. Different categories of endophthalmitis displayed diversified bacterial composition.

Comparative evaluation of modified crater (endonucleation) chop and conventional crater chop techniques during phacoemulsification of hard nuclear cataracts: A randomized study.

Purpose:To compare the clinical outcomes of endonucleation chop (EC) versus conventional crater (CC) chop techniques in phacoemulsification of hard nuclear cataracts.Methods:In this Prospective, longitudinal, randomized controlled study with double-blinding. Hundred consecutive eyes with uncomplicated cataracts (nucleus grades 3 and 4) were equally divided into Group A (EC) and Group B (CC). Intraoperative effective phacoemulsification time (EPT) and balanced salt solution (BSS) volume used was noted. Postoperative central corneal thickness (CCT), endothelial cell density (ECD), uncorrected Visual Acuity (UCVA), best-corrected visual acuity (BCVA), and IOP were recorded at days 1, 7, 30, and 90 postoperatively. The Chi-square test (categorical data), Mann–Whitney U test, and t-tests for other parameters were done.Results:The mean EPT in Groups A and B were 6.6 and 14.25 s, respectively (P < 0.001). The BSS volume used was 105.9 and 221.7 mL, respectively (P < 0.001). At 3 months, the ECD loss was 4.35 and 8.6%, respectively (P = 0.025). The-first day CCT was significantly increased in Group B but was the same in both groups at 3 months. A significant improvement in BCVA was noted in both groups. This new technique significantly reduces EPT, the BSS used, and ECD loss.Conclusion:Compared with the CC chop technique, the EC technique for phacoemulsification of hard nuclear cataracts conserved phacoemulsification energy and minimized exposure to the intraocular irrigating solution, provided a significant reduction in corneal endothelial damage, and led to faster visual rehabilitation.

Establishing Evidence for Use of Appropriate Medicines in the Operating Room

Various issues related to clinical use of medicines remain unclear, and pharmacists are expected to establish evidence for appropriate use of medicines. The present review summarizes our findings from three areas of research regarding the use of medicines in the operating room: 1) We evaluated the extent of extravasation injury due to thiopental (2.5 mg/100 μL) and propofol (1.0 mg/100 μL) at the macroscopic and histopathologic levels in a rat model. Thiopental, which causes tissue necrosis, can be classified as a "vesicant", and propofol can be classified as an "irritant". Moreover, warming strongly exacerbated the degeneration or necrosis induced by extravasation of thiopental. 2) The cytotoxicity of povidone-iodine solution (PVP-I) for ophthalmic use and that of polyvinyl alcohol-iodine solution (PAI) was compared using a human corneal epithelial cell line. Despite exhibiting equivalent antiseptic effects, the cytotoxicity of PVP-I diluted 16-fold was greater than that of PAI diluted 6-fold. After inactivation of iodine, the cytotoxicity of PVP-I persisted; therefore, to avoid corneal damage, antisepsis should be achieved with PAI. 3) The stability of 1 μg/mL adrenaline when used as an intraocular irrigating solution to maintain pupil dilation was evaluated. After mixing for 6 h, the adrenaline concentration was 65.2% (pH 8.0) of the initial concentration. Moreover, the low concentration of sodium bisulfite in the irrigating solution could have caused adrenaline reduction. Our results strongly suggest that intraocular irrigation solution containing adrenaline should be prepared just prior to use in surgery.

The effect of different intraocular irrigating solutions on lens opacity after pars plana vitrectomy for proliferative diabetic retinopathy

The effect of different intraocular irrigating solutions on lens opacity after pars plana vitrectomy for proliferative diabetic retinopathy

Stability of Adrenaline in Irrigating Solution for Intraocular Surgery.

Intraocular irrigating solution containing 1 µg/mL adrenaline is widely used during cataract surgery to maintain pupil dilation. Prepared intraocular irrigating solutions are recommended for use within 6 h. After the irrigating solution is admistered for dilution, the adrenaline may become oxidized, and this may result in a decrease in its biological activity. However, the stability of adrenaline in intraocular irrigating solution is not fully understood. The aim of this study was to evaluate the stability of adrenaline in clinically used irrigating solutions of varying pH. Six hours after mixing, the adrenaline percentages remaining were 90.6%±3.7 (pH 7.2), 91.1%±2.2 (pH 7.5), and 65.2%±2.8 (pH 8.0) of the initial concentration. One hour after mixing, the percentages remaining were 97.6%±2.0 (pH 7.2), 97.4%±2.7 (pH 7.5), and 95.6%±3.3 (pH 8.0). The degradation was especially remarkable and time dependent in the solution at pH 8.0. These results indicate that the concentration of adrenaline is decreased after preparation. Moreover, we investigated the influence of sodium bisulfite on adrenaline stability in irrigating solution. The percentage adrenaline remaining at 6 h after mixing in irrigating solution (pH 8.0) containing sodium bisulfite at 0.5 µg/mL (concentration in irrigating solution) or at 500 µg/mL (concentration in the undiluted adrenaline preparation) were 57.5 and 97.3%, respectively. Therefore, the low concentration of sodium bisulfite in the irrigating solution may be a cause of the adrenaline loss. In conclusion, intraocular irrigation solution with adrenaline should be prepared just prior to its use in surgery.

The effect of epinephrine in intraocular irrigation solution on retinal vascular caliber and macular thickness

Objective To observe the effect of epinephrine in intraocular irrigation solution on retinal vascular caliber and macular thickness. Methods A prospective control study. 32 eyes of 32 patients with macular hole who underwent vitrectomy were enrolled in this study. The patients including 14 males (14 eyes) and 27 females (18 eyes), with the average age of (64.0±4.5)years. Uncorrected visual acuity, corrected visual acuity, slit lamp biomicroscopy, indirect ophthalmoscopy, fundus color photography and optical coherence tomography were performed in all patients. Retinal vascular caliber located in 0.5 - 1.0 disc diameter from optic disk was measured from digital fundus photographs and summarized as central retinal artery (CRAE) and vein (CRVE) equivalents in all eyes at baseline and at the 1 month, 3 months follow-up visit. The macular thickness is the distance from retinal interface of inner plexiform layer to retinal pigment epithelium layer. The macula was divided into inner ring ( 0.05). The difference of macular thickness between inner ring and outer ring was not significant (P>0.05). The average follow-up was 3.5 months. CRAE, CRVE and macular thickness in inner ring and outer ring before and 1 month, 3 months after surgery were comparatively analyzed. Results The differences of CRAE and CRVE before and 1, 3 months after surgery both in experiment group (tCRAE=0.322, 0.148; tCRVE=0.317, 0.005) and control group (tCRAE=0.226, 0.137; tCRVE=0.284, 0.151) were not significant (P>0.05). The differences of CRAE (t=0.624, 0.424) and CRVE (t=0.015, 0.041) between experiment group and control group also were not significant (P>0.05). The differences of macular thickness in inner ring and outer ring before and 1, 3 months after surgery both in experiment group (tinner=0.322, 0.148; touter=0.317, 0.005) and control group (tinner=0.226, 0.137; touter=0.284, 0.151) were not significant (P>0.05). The differences of macular thickness in inner ring (t=1.568, 0.373) and outer ring (t=-1.697, 0.536) between experiment group and control group also were not significant (P>0.05). Conclusion Epinephrine (1∶1000) in intraocular irrigation solution has no effect on retinal vascular caliber and macular thickness in patients with macular hole. Key words: Retinal vessels/physiopathology; Macula lutea/physiopathology; Epinephrine/toxicity; Retinal perforations/surgery

Clinical study of pain sensation during phacoemulsification with and without cryoanalgesia

To compare the analgesic efficacy of 2 types of anesthetic techniques-topical and topical associated with cryoanalgesia-during cataract surgery. Department of Ophthalmology, University of São Paulo, Ribeirão Preto, Brazil. Prospective randomized study. Patients with symmetrical bilateral cataract had phacoemulsification with the use of an intraocular irrigation solution at room temperature in 1 eye and a cold (4°C) solution in the contralateral eye (Group 2). The pain related to the procedure was assessed using a visual analog scale ranging from 0 to 100, with 0 representing no pain and 100 the worst pain. In addition, endothelial cell loss, the change in corneal thickness, and visual acuity were evaluated 30 days ± 2 (SD) after each surgery. The surgery duration, total irrigation volume, phacoemulsification time, and ultrasound power used were analyzed. The study enrolled 25 patients (50 eyes). There was no statistically significant difference in the mean pain score between Group 1 (26.0 ± 3.7) and Group 2 (21.3 ± 3.6) (P = .2016, paired t test). No significant difference was found in the mean corneal endothelial cell loss (Group 1: 10.0% ± 0.4%; Group 2: 9.9% ± 0.3%; P = .7576), corneal thickness increase (Group 1: 1.5 ± 1.0 μm; Group 2: 1.4 ± 0.9 μm; P = .9340), or visual acuity gain (Group 1: 0.54 ± 0.06 logMAR; Group 2: 0.55 ± 0.09 logMAR; P = .8208). There is no difference in the intensity of pain during phacoemulsification with the use of topical anesthesia or topical anesthesia associated with cryoanalgesia. No author has a financial or proprietary interest in any material or method mentioned.

Comparison between effects of Ringer′s and Ringer′s lactate irrigating solutions on corneal endothelium during phacoemulsfication

Purpose The aim of this study was to compare the effect of phacoemulsification on the corneal endothelium using Ringer's and Ringer's lactate as the intraocular irrigating solution. Setting Mansoura Ophthalmic Centre, Faculty of Medicine, Mansoura University, Egypt. Design Prospective randomized comparative study. Materials and methods A total of 102 eyes of 102 patients with senile cataract were randomized to have phacoemulsification with foldable intraocular lens implantation performed using Ringer's (group 1) or Ringer's lactate (group 2) as the intraocular irrigating solution. Specular microscopy was done preoperatively, 1 week and 3 months postoperatively to evaluate endothelial cell density (ECD), coefficient of variation (CV), and central corneal thickness. Data were analyzed using the t -test, the Mann-Whitney U -test, and the Pearson correlation coefficient. Results Mean ECD was 2532 cells/mm 2 preoperatively, 2345 cells/mm 2 1 week, and 2284 cells/mm 2 3 months postoperatively in group 1, and 2526, 2374, and 2322 cells/mm 2 , respectively, in group 2. There was a statistically significant difference between preoperative ECD and each of 1 week and 3 months postoperative ECD in each group. No significant difference was found between 1-week mean ECD reduction in group 1 (7.35%) and group 2 (6.05%) or between 3-month mean ECD reduction in group 1 (9.69%) and group 2 (8.07%). Conclusion Ringer's and Ringer's lactate solutions are associated with minimal changes in corneal ECD, morphology, and function during uncomplicated phacoemulsification with foldable intraocular lens implantation in patients with normal endothelial cell counts. There is no clinically significant difference in endothelial cell preservation and polymegathism and corneal swelling between Ringer's and Ringer's lactate solutions.

Impedimetric detection of whole blood concentration for early detection of intraocular hemorrhage

Early detection of retinopathy can substantially reduce the risk of visual impairment and blindness in diabetes mellitus (DM) patients. Screening tool such as Amsler grid may be useful for the early detection of maculopathy in DM patients, but the metamorphopsia by Amsler gird self-screening is subjectively, not objectively. Although some kinds of optical imaging instruments have been used for the early detection of retinopathy, self-testing regularly is still not possible. In this work, impedimetric detection of whole blood concentration is proposed to be a promising technique to detect intraocular hemorrhage. An intraocular implant chip is also discussed to integrate the impedimetric detection into a CMOS IC. Results revealed that the impedimetric measurement could indicate 5% (v/v) whole blood in intraocular irrigating solution. Such technique is a label-free, non-invasive, and real-time analytical method. The preliminary results showed that impedimetric measurement had high potential to be implemented to an intraocular implant chip.

A Clinical Comparison of Safety and Efficacy in Phacoemulsification with versus without Ophthalmic Viscoelastic Device

Purpose: To evaluate in a comparative manner the safety and efficacy of 1.0% sodium-Hyaluronate used during capsulorhexis and intraocular lens (IOL) implantation in phacoemulsification surgery. Materials and Methods: 1.0% sodium-Hyaluronate, which is commonly used as one of the ophthalmic viscoelastic devices, was compared to intraocular irrigating solution, which can bring up these effects. In addition, the effect of both methods on occurring corneal endothelial cell (CEC) loss was investigated. Results: Each group comprised 19 eyes. The mean preoperative CEC density was 2525.68 ± 181.85 in Group H and 2514.16 ± 174.59 in Group V; no statistically significant difference was found between the groups (p > 0.05). Preoperative and postoperative first and twelfth week CEC densities were 2438.21 ± 198.12 (p < 0.001) and 2390.74 ± 202.31, respectively, in group H (p < 0.001). Preoperative and postoperative first and twelfth week CEC densities were 2415.32 ± 197.24 (p < 0.001) and 2353.47 ± 212.69 in group V (p < 0.001). Compared with preoperative values, decrease in CEC density on the postoperative first and twelfth weeks was not statistically significant in either group (p > 0.05). Conclusion: Although it was found that there was no statistically difference in terms of preventing CEC loss between 1.0% sodium-Hyaluronate and the irrigation method during phacoemulsification, it was observed clinically that 1.0% sodium-hyaluronate can make the procedure easy, safer, very helpful, especially for understanding phacoemulsification.

Effect on corneal endothelial cell loss during phacoemulsification: Fortified balanced salt solution versus Ringer lactate

To compare the effect of phacoemulsification on the corneal endothelium using fortified balanced salt solution (BSS Plus) and Ringer lactate as the intraocular irrigating solution. P.D. Hinduja Hospital, Mumbai, India. Prospective randomized controlled double-blinded clinical study. Patients with senile cataract up to nuclear grade III were randomized to have phacoemulsification with posterior chamber intraocular lens implantation performed using fortified balanced salt solution (Group A) or Ringer lactate (Group B) as the intraocular irrigating solution. The corneal endothelial cell density (primary outcome) and pachymetry were measured preoperatively and 1 week and 1 and 6 months postoperatively. Each group comprised 35 eyes (35 patients). The postoperative percentage of endothelial cell loss was not significantly different between the 2 groups at 1 week (P=.582), 1 month (P=.668), or 6 months (5.03% and 8.35% in Group A and Group B, respectively) (P=.483) and was within the limits reported in the literature. The postoperative percentage change in pachymetry was not significantly different between the 2 groups at 1 week (P=.179) or 1 month (P=.170) but was significant at 6 months (P<.001) (-1.59% and 0.54% in Group A and Group B, respectively); however, the mean pachymetry value was near baseline in both groups at 6 months. Corneal endothelial cell loss after phacoemulsification with Ringer lactate was similar to that with fortified balanced salt solution over the long term.

Testing the Biocompatibility of a Glutathione-containing Intraocular Irrigation Solution by Using an Isolated Perfused Bovine Retina Organ Culture Model — an Alternative to Animal Testing

The effects of a glutathione-containing intra-ocular irrigation solution, BSS Plus©, on retinal function and on the survival of ganglion cells in whole-mount retinal explants were studied. Evidence is provided that the perfused ex vivo bovine retina can serve as an alternative to in vivo animal testing. Isolated bovine retinas were prepared and perfused with an oxygen-saturated standard irrigation solution, and an electroretinogram was recorded to assess retinal function. After stable b-waves were detected, the isolated retinas were perfused with BSS Plus for 45 minutes. To investigate the effects of BSS Plus on photoreceptor function, 1mM aspartate was added to the irrigation solution in order to obtain a-waves, and the ERG trace was monitored for 75 minutes. For histological analysis, isolated whole retinal mounts were stored for 24 hours at 4°C, in the dark. The percentages of cell death in the retinal ganglion cell layer and in the outer and inner nuclear layers were estimated by using an ethidium homodimer-1 stain and the TUNEL assay. General swelling of the retina was examined with high-resolution optical coherence tomography. During perfusion with BSS Plus, no significant changes in a-wave and b-wave amplitudes were recorded. Retinas stored for 24 hours in BSS Plus showed a statistically significant smaller percentage (52.6%, standard deviation [SD] = 16.1%) of cell death in the retinal ganglion cell layer compared to the control group (69.6%, SD = 3.9, p = 0.0031). BSS Plus did not seem to affect short-term retinal function, and had a beneficial effect on the survival of retinal ganglion cells. This method for analysing the isolated perfused retina represents a valuable alternative for testing substances for their retinal biocompatibility and toxicity.

Comparing the Effects of Two Different Irrigation Solutions on an Isolated Perfused Vertebrate Retina

Purpose: To compare the effect of a taurine-containing intraocular irrigation solution (PuriProtect™) to a standard irrigation solution (BSS™) we evaluated the retinal function using an electroretinogram (ERG) and analyzed the survival of retinal ganglion cells on isolated whole mount retinas. Materials and Methods: During ERG recordings, each irrigation solution was superfused for 45 min with the relevant irrigation solution. To investigate the effects on photoreceptor function, 1 mM asparate was added to obtain a-waves. The recovery of the a- and b-wave was monitored after superfusing the retinas with standard medium again. To evaluate the percentage of dead ganglion cells, retinas were stored for 24 h at 4°C in darkness and after staining the retinas with ethidium homodimer-1 the retinas were analyzed using fluorescence microscopy. Results: The application of standard medium supplemented with 2 mM taurine resulted in a significant increase of the b-wave amplitude compared to standard medium alone. The a-wave amplitudes showed no significant changes under taurine supplementation. Compared to standard medium BSS showed no significant decrease in b-wave amplitudes, but a significant decrease in a-wave amplitudes. In contrast to BSS there were no significant changes in the a- or b-wave amplitudes detectable after the application of PuriProtect. At the end of the washout period no significant changes in a- or b-wave amplitudes were recorded for any tested irrigation solution. Retinas stored for 24 h in PuriProtect or in standard medium with taurine had a statistically significant smaller amount of dead cells than retinas stored in standard medium without taurine supplementation. Conclusions: BSS does not seem to be an ideal irrigation solution, because it compromises the a-wave in the ERG. In contrast to BSS, PuriProtect showed no significant impact on the ERG and showed a better long-term effect on ganglion cell survival. Taurine supplementation, therefore, seems to be neuroprotective and its supplementation to an intraocular irrigation solution favorable for the retina.

In vitro compatibility study of cephalosporin with intraocular irrigating solutions and intracameral medications

To study the compatibility of cephalosporins with intraocular irrigating solutions and intracameral medications commonly used in cataract surgery. The was an in vitro experiment conducted in the Research Laboratory of the Department of Microbiology, the Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong. Three cephalosporins--cefazolin, cefuroxime and ceftazidime--were separately diluted and mixed with irrigating solutions and intracameral medications to form 192 samples and 12 control solutions. The cephalosporins were dissolved in normal saline and further diluted to the concentration of 1 mg in 0.1 mL with normal saline, Ringer's solution, balanced salt solution and fortified balanced salt solutions. These were mixed with balanced salt solutions or fortified balanced salt solutions, with adrenaline, acetylcholine or carbachol and kept at 37°C for 2 h. The concentrations of free cephalosporins were measured with rapid high-performance liquid chromatography at baseline (0 h) and at 2 h. Free concentrations of cephalosporins at 2 h were compared with mean baseline (0 h) value. A difference of 3 standard deviations or more was considered statistically significant. At 2 h there was a significant drop in the cefuroxime concentration in preparations in which cefuroxime was diluted with normal saline (P < 0.01). In all preparations, the final concentrations of cephalosporins were higher than the minimal inhibitory concentrations (MIC(90)) for microbials commonly isolated from the external eye. Cefazolin, cefuroxime and ceftazidime were compatible with irrigating solutions and intracameral medications commonly used in cataract surgery.

Effect of heparin in the intraocular irrigating solution on postoperative inflammation in the pediatric cataract surgery

To evaluate the influence of irrigation of the anterior chamber with heparin sodium on postoperative inflammation after pediatric cataract surgery. Kartal Training and Research Hospital, First Eye Clinic, Istanbul, Turkey. Randomized prospective double-blind study. Fourteen consecutive eyes from 14 patients aged 8.9 +/- 5.9 years, (range 3-18 years) (group 1) and 19 eyes from 19 patients aged 9.1 +/- 5.2 (range 1.5-18 years) (group 2) underwent pediatric cataract surgery. Five patients in group 1 were between three and five years old. One patient was 1.5 years old and six patients in group 2 were between three and five years old. During the procedure, group 1 received anterior chamber irrigation with heparin sodium (5 IU/cc) and 1 ml of heparin sodium (concentration 10 IU/ml) added to the irrigating balanced salt solution (BSS Plus; Alcon Laboratories, Inc., Fort Worth, TX, USA) while group 2 received BSS without heparin sodium only. Cases aged under three years received anterior vitrectomy in addition to posterior capsulorrhexis. One eye received anterior vitrectomy in group 1 and two eyes received anterior vitrectomy in group 2. Cases with preoperative complications were not included in the study. Early and late postoperative inflammatory complications, including fibrin formation, anterior and posterior synechia, cyclitic and pupillary membrane formation were recorded and compared. Mild anterior chamber reaction was observed in three patients in Group 1, while nine cases in group 2 experienced marked anterior chamber reaction. In four of nine patients from group 2, anterior chamber reaction was severe and resulted in pupillary membrane and synechia despite treatment in the postoperative 7th day, while in all three cases in group 1, reaction disappeared by the 7th day. Anterior chamber irrigation with heparin during pediatric cataract surgery may minimize early inflammatory reaction and decrease the number of postoperative inflammatory related complications.

Effect of room temperature and cooled intraocular irrigating solution on the cornea and anterior segment inflammation after phacoemulsification: a randomized clinical trial

To compare the effects of cooled and room temperature BSS Plus solution on the central corneal thickness (CCT), anterior segment inflammation, and corneal endothelium in patients undergoing phacoemulsification. In this prospective, randomized study, 70 consecutive patients undergoing phacoemulsification were assigned to one of two groups: Group 1 (controls) (n=35) received BSS Plus at a room temperature of 23 degrees C and Group 2 (cases; n=35) received BSS Plus cooled at 10 degrees C. In both the groups, the percentage of difference for CCT, absolute change in endothelial cell density, and coefficient of variation (CV) from preoperative to postoperative periods was analysed. The presence of anterior chamber flare and cells were compared postoperatively between the two groups. There was no significant difference in percentage change for CCT from preoperative to postoperative days 1, 7, and 30 between the two groups (P=0.30, P=0.56, and P=0.52). There was no statistically significant difference in the ECD loss (P=0.19) and CV (P=0.88) at 1 month between the two groups. The influence of the solutions on anterior chamber flare and cells was not statistically significant between the two groups on the first postoperative day (P=0.17, P=0.11). The temperature of the BSS Plus solution did not affect any parameter of the study. The use of moderately cooled BSS had no detectable effect and benefit on the outcome of the surgery.