Muhammad Rafiq, Imran Ahmad, Habib Ullah.
Comparison of Effects on Corneal Endothelium of A Low Cost & Expensive Combination of Viscoelastic Material & Irrigating Solution in Phacoemulsification.
Ophthalmol Update Jan ;12(1):40-2.

Purpose: To see the protective effect on corneal endothelium of a cheap and an expensive combination of a dispersive viscoelastic material and an irrigating solution in phacoemulsification. Setting: Department of Ophthalmology, Rehman Medical Institute, Peshawar. Methods: In this prospective randomized study, we selected 90 eyes of 45 consecutive patients with senile cataracts bilaterally. The first eye of each patient randomly received hydroxypropyl-methylcellulose 2% and Ringer?s solution (low-cost combination)or sodium chondroitin sulfate 4%?sodium hyaluronate 3% and an enriched balanced salt solution (BSS Plus®) (expensive combination) during phacoemulsification. While the contralateral eye received the other treatment. Endothelial cell function was evaluated by measuring corneal thickness (CT) using pachymetry and endothelial cell counts by specular microscope. Results: Postoperative increase in CT was +9.5µm in the low-cost group and +10.3µm in the expensive group; the difference between groups was insignificant. After 1 month, the CT still differed significantly from the baseline in the low-cost group while in the expensive group, recovery was good. Three months after surgery, the CT had returned to baseline values in both groups and at this stage, there was no significant difference between the groups. Conclusions: During phacoemulsification in a non-selected patient population, there was no difference in acute postoperative corneal edema and endothelial cell counts at 3 months between an expensive and a low cost combination. Eyes which received the expensive combination had faster recovery of corneal swelling at 1 month. However, the cost of expensive combination is 6-7 times that of low-cost combination.

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