THE INFLUENCE OF VISCOELASTIC TYPE ON CORNEAL ENDOTHELIAL CELL LOSS DURING PHACOEMULSIFICATION

One of the most important factors for successful intraocular surgery is deep anterior chamber which is maintained using viscoelastics that protect corneal cells. This single cell layer could be injured during surgery to varying degrees and is known to be incapable of regeneration. The aim of the study was to determine the optimal viscoelastic for the protection of corneal cells during phacoemulsification and intraocular lens implantation. 156 patients were included in this prospective study. Patients were randomly assigned to three groups based on type of viscoelastic used. In the first group 1, 4% sodium hyaluronate was used, in the second group combination of 4% sodium chondroitin sulfate and 3% sodium hyaluronate, and in the third group 3% hyaluronate was used. Endothelial cell count and morphology changes were determined centrally with a specular microscope, one day before, seventh day and one month after surgery. Intraocular pressure was measured before surgery, and six hours, 24 hours, 7 and 30 days after surgery. Pachymetry, as a measure of endothelial pump function, was evaluated before surgery and 7 and 30 days postoperatively. All surgeries were performed by two surgeons using the same technique. Endothelial cells loss was lowest (16.1%) eyes protected with combination of 4% sodium chondroitin sulfate and 3% sodium hyaluronate. In group where 1, 4% sodium hyaluronate was used, loss was 7, 6% and in group where 3% hyaluronate was used 7, 9%. Although cell loss was not significant ly different among three groups, lowest morphology change rate recorded in group 2 suggest that a combination of chondroitin and hyaluronate offers the best protection. There was no statisticaly significant difference in postoperative intraocular pressure increase and pachymetry values between the investigated groups.