Transcript スライド 1

Ingenuity method using viscoadaptive
device to protect endothelial cell damage
during cataract surgery
Yoshihiro Koide1
Contributing authors:
Hiroyuki Matsushima1, Tadashi Senoo1, Kotaro Oki2
1Department of Opthalmology Dokkyo Medical University(Japan)
2Oki Eye Surgery Center(Japan)
No Financial Interest
Purpose
Remaining ophthalmic visco device (OVD) in
anterior chamber (AC) during
phacoemulcification (PEA) is important to
protect endothelial cells.
In this study an ingenious method to remain
OVD during PEA is evaluated.
We found differences by method of
injecting OVD for remaining in AC.
Usual exchange
When the OVD inject from center
of cornea, it is difficult to fill OVD
on peripheral.
Complete exchange
When the OVD inject from opposite
side of incision, it is easy to fill out
OVD completely.
Is complete exchange effective?
1. Healon V (AMO) is prepared and stained
with fluorescein sodium for visualize.
2. Two different OVD exchange methods are
performed to pig eyes.
3. Remained OVD is observed after PEA.
Grade 0: OVD is disappeared from AC at end of PEA.
Grade 1: OVD is partially remained in AC at end of PEA.
Grade 2: OVD is remained in AC at end of PEA.
Is complete exchange effective?
Usual exchange
Complete exchange
Pre
Pre
Post
Post
The OVD partially disappeared
after PEA.
The OVD still remained in AC
after PEA.
Is complete exchange effective?
Usual exchange Complete exchange
Grade
2
1
0
0
0.5
1
1.5
2
Five surgeons tests the two different methods. The
complete exchange is effective to remain OVD in AC
after PEA.
2.5
Clinical evaluation
• 36 cataract patients are randomly separated
into two groups.
V-group (18 eyes)
S-group (18 eyes)
Complete exchange by Healon V (AMO) Soft-shell technique using Viscort (Alcon)
and Healon (AMO)
Viscort
Healon V
Healon
Clinical evaluation
• PEA is performed using Accurus (Alcon).
– Bottle height 60 cm,
– Aspiration 160 mmHg, power 70%
• Percentages of corneal endothelial cell loss
and ocular pressure are measured 1,3 and 6
months postoperatively.
• Unpaired t-test is performed for statistical
analysis.
The percentages of endothelial cell loss
4.0%
3.5%
＊
＊
＊
3.0%
2.93
2.5%
2.0%
2.84
V-group
S-group
2.14
1.5%
1.54
1.0%
0.5%
1.13
0.75
0.0%
1M
3M
6M
＊Unpaired t-test; P<0.05
The percentages of endothelial cell loss was lower
in V- group than in S-group.
Intraocurar Pressure
mmHg
17
16
15
14
V-group
13
S-group
12
11
10
pre operation
1W
1M
3M
6M
＊There are no statistically significance.
There are no differences of intraocular pressure
preoperatively between two groups.
Conclusion
• Healon V was able to remain AC by ingenious
complete exchange methods after PEA.
• Complete exchange AC using Healon V was
effective to protect endothelial cell loss.
To protect endothelial cell loss…
Complete exchange
• Not only the types of
OVD but also the
injection method of
OVD during PEA were
important to protect
endothelial cell loss.
When the OVD inject from opposite
side of incision, it is easy to fill out
OVD completely.