Purpose: To evaluate transient increases in intraocular pressure (IOP) after use of high-viscosity viscoelastic agents in cataract surgery. Setting: Military Hospital, Ulm, Germany. Methods: In a prospective, randomized study, we evaluated IOP following cataract surgery using two different viscoelastic substances (Healon®, Healon® GV). The viscosity of Healon GV is 10 times higher than that of Healon because of higher concentration and molecular weight. Patients having identical phacoemulsification procedures (sutureless clear corneal tunnel incision with foldable silicone lens implantation) (N = 60) and identical viscoelastic removal were assigned to groups of 15 based on viscoelastic used and removal time (20 or 40 seconds). Intraocular pressure was measured preoperatively and at 6, 24, 36, and 48 hours and 1 month postoperatively. Results: The highest mean IOP elevations in both viscoelastic groups were obtained at 24 hours postoperatively (2.9 mm Hg ± 4.3 [SD] with Healon and 3.3 ± 6.3 mm Hg with Healon GV). There were no statistically significant differences between the two viscoelastics and the two removal times during the entire follow-up period (unpaired t-test), but standard deviations were higher in the Healon GV groups at 6 and 24 hours. Two patients in the Healon groups and three in the Healon GV groups required medical treatment for IOP within the first 24 postoperative hours; however, all five patients had an IOP lower than 22 mm Hg on the second postoperative day. Conclusions: Based on postoperative IOP, both viscoelastics can be equally well removed from the anterior chamber. Incidence of high IOP using high-viscosity hyaluronic acid is minimized by the described removal technique.

Evaluation of intraocular pressure with Healon and Healon GV in sutureless cataract surgery with foldable lens implantation

Sodium Hyaluronate in Cataract Surgery: II. Report on the Use of Healon® in Extracapsular Cataract Surgery Using Phacoemulsification

Sodium Hyaluronate in Cataract Surgery: I. Report on the Use of Healon® in Two Different Types of Intracapsular Cataract Surgery

Healon (sodium hyaluronate) has been used in a prospective study designed to investigate its possible usefulness in promoting effective bleb formation and preventing cleft closure in trabeculectomy for glaucoma. One hundred fourteen patients with open-angle glaucoma were randomly assigned to one of two groups. In one group (55 patients), filtering surgery was performed without the use of Healon. In the remaining 59 patients, Healon was used to separate the iris from the cleft, the sclera from the sclera and the conjunctiva from the sclera. The surgical procedure used was the Stallard-Worst triangular modification of Cairns' method, combined with removal of the Tenon's capsule. The patients whose operations were performed with the aid of Healon had a higher success rate, as manifested by better and more permanent bleb formation and maintenance, more open clefts, less scarring, less peripheral anterior synechiae formation, and significantly lower long-term intraocular pressure. Moreover, the number of patients requiring supplemental postoperative timolol therapy was significantly smaller in the Healon group (5/59 patients: 8.5%) than in the control group (33/55 patients: 60%). There was a transient delay in the reduction of intraocular pressure following trabeculectomy in the Healon patients which was not observed in control patients. Apart from this, no adverse effects were associated with the use of Healon.

Sodium hyaluronate (Healon) in glaucoma filtering procedures.

Background Viscoelastic substances are used in anterior segment surgery to reduce tissue trauma and endothelial cell loss and to serve as space maintainer Healon®GV ( greater viscosity), a hyaluronic acid product with a ten times higher viscosity than Healon®, is utilized in complicated procedures (vitreous pressure, flat anterior chamber, congenital cataracts, etc) and often in phacoemulsification Intraocular pressure (IOP) rise following incomplete removal is a known problem Materials and methods A prospective randomized study was performed to evaluate the IOP following cataract surgery with Healon® or Healon®GV and different removal times (RT) Forty patients (forty eyes) having uncomplicated phacoemulsification with foldable silicone posterior chamber lens implantation and identical viscoelastic removal technique were assigned to four groups : Healon® with 20 or 40 seconds (sec) RT, Healon®GV with 20 or 40 sec RT All surgeries were performed by the same surgeon using the same technique especially for the removal of the viscoelastic All patients had an identical pre- and postoperative medication Intraocular pressures were obtained using Goldman's applanation tonometry preoperatively, six, 24, 36, and 48 hours postoperatively Results The IOP follow-up showed no significant difference between the two viscoelastic substances and the two different removal times of 20 and 40 sec (t-test) In four patients (two of the Healon®-groups, two of the Healon®GV-groups) the IOP required treatment On the second postoperative day, the same four patients showed IOP lower than 22 mm Hg The highest mean-IOP (mm Hg) in both Healon-groups was obtained at 24 hours postoperatively: 185±39 SD (Healon®) ; 173±59 SD (Healon®GV) Conclusion The incidence of postoperative rise in IOP using high viscosity hyaluronic acid (Healon®GV) can be minimized by the applied removal technique Both viscoelastics - despite of higher molecular weight and viscosity - can be removed equally from the anterior chamber following phacoemulsification and posterior chamber lens implantation utilizing IOP as a parameter in vivo

Postoperative intraocular pressure in the first days after intraocular administration of hyaluronic acid solution with different viscosities

Now that a clinically suitable viscous substance (Healon) has become available for use in ophthalmic surgery, it is worthwhile to examine in greater depth the problems of tactility and methods of resolving them with viscous substances. These are not simple substitutes for aqueous humor which, once introduced, may be left in the eye. It is more appropriate to compare them with mechanical instruments employed for a specific purpose and subsequently removed. Thanks to their stabilizing effect, viscous substances increase safety in many types of manipulation. However, their use calls for a thorough knowledge of their side-effects. This has to be learned, as is the case with any new instrument.

Der raumtaktische Einsatz einer viskösen Substanz (Healon

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Der raumtaktische Einsatz einer viskösen Substanz (Healon