A proteção endotelial na facectomia: avaliação de nova substância visco-elástica sintética

A proteção endotelial na facectomia: avaliação de nova substância visco-elástica sintética

Autores:

Emyr Francisco Soares

ARTIGO ORIGINAL

Arquivos Brasileiros de Oftalmologia

versão impressa ISSN 0004-2749versão On-line ISSN 1678-2925

Arq. Bras. Oftalmol. vol.62 no.1 São Paulo fev. 1999

http://dx.doi.org/10.5935/0004-2749.19990061

SUMMARY

Purpose:

To evaluate the clinical safety and effectiveness of the novel synthetic viscoelastic solution MEDILON (polyacrylamide).

Methods:

60 cataract patients were randomly divided into 3 groups of 20 patients. Upon extracapsular cataract extraction Group 1 received injected air in the anterior chamber for endothelium protection, Group 2 received HEALON ( sodium hyaluronate) and Group 3 received MEDILON (polyacrylamide). Preoperative and postoperative ( 1 day and 3 months) examinations were conducted as well as a comparative study between groups evaluating endothelial cell count, intraocular pressure variation, corneal thickness, incision type, postoperative complications and surgeons' subjective impressions.

Results:

Endothelial cell loss was similar in Group 2 (Healon) and Group 3 (Medilon), and higher in Group 1 (Air). Regarding all other clinical aspects there were no statistically significant differences between Groups 2 and 3. As to the surgeons subjective impressions there was a discreet preference for polyacrylamide over sodium hyaluronate.

Conclusions:

Our results suggest that the clinical safety and effectiveness of polyacrylamide as a viscoelastic substance for intraocular use is comparable to sodium hyaluronate.

Keywords: Endothelial protection; Polyacrilamide; Sodium hyaluronate; Viscoelastics

REFERÊNCIAS

1 Pape LG, Balazs EA. The use of sodium hyaluronate (Healon) in human anterior segment surgery. Ophthalmology 1980;87:699-705.
2 Graue EL, Polack FM, Balazs EA. The protective effect of sodium hyaluronate to corneal endothelium. Exp Eye Res 1980;31:119-27.
3 Polack FM. Healon (Na hyaluronate). A review of the literature. Cornea 1986;5:81-93.
4 Boume WM, Kaufman HE. Endothelial damage associated with intraocular lenses. Am J Ophthalmol 1976;81:482-5.
5 Perrit RA. The use of Healon in anterior chamber lens implantation. Am Intraocul Implant Soc J 1982;8:55-8.
6 Bourne WM, Liesegang TJ, Walter RR et al. The effect of sodium hyaluronate on endothelial cell damage during extracapsular cataract extraction and posterior chamber lens implantation. Am J Ophtalmol 1984;98:759-65.
7 Holmberg AS, Philipson BT. Sodium hyaluronate in cataract surgery. 1. Report on the use of Healon in two different types of intracapsular cataract surgery. Ophthalmology 1984;91:45-52.
8 Idem: Sodium hyaluronate in cataract surgery, 2. Report on the use of Healon in extracapsular cataract surgery using phacoemulsification. Ibid: 53-9.
9 Alpar JJ. Comparison of Healon and Amvisc. Ann Ophthalmol 1985;17:647-51.
10 Percival SPB. Results of a clinical trial of sodium hyaluronate in lens implantaion surgery. Am Intraocul lmplant Soc J 1985;1 1:257-9.
11 Sharpe ED, Simmons RJ. A prospective comparison of Amvisc and Healon in cataract surgery. J Cataract Refractive Surg 1986;12:47-9.
12 Percival SPB. Complications from use of sodium hyaluronate (Healonid) in anterior segment surgery. Brit J Ophthalmol 1982;66:714-6.
13 Barron BA, Busin M, Page C et al. Comparison of the effect of Viscoat and Healon on postoperative intraocular pressure. Am J Ophthalmol 1985;100:377-84.
14 Embriano PG. Postoperative pressures after phacoemulsification: sodium hyaluronate vs. Sodium condroitin sulphate-sodium hyaluronate. Ann Ophthalmol 1989;21:85-90.
15 Olivius E, Thorburn W. Intraocular pressure after cataract surgery with Healon. Am Intraocul Implant Soc J 1985;11:480-2.
16 Roberts B, Peiffer RL. Experimental evaluation of a synthetic viscoelastic material on intraocular pressure and corneal endothelium. J Cataract Refract Surg 1989;15:321-6.
17 Pape LG. Intracapsular and extracapsular of lens technique of lens implantation with Healon. Am Intraocul Implant Soc J 1980;6:342-3.
18 Miller D, Stegmann R. The use of Healon in intraoeular lens implantation. Int Ophthalmol Clin 1982;22:177-187.
19 Frey LL. Postoperative intraoeular pressure rises: a comparison of Healon, Amvisc and Viscoat. J Cataract Refract Surg 1989;15:415-20.
20 Lindquist DT, Edenfield B. Citotoxicity of viscoelastics on cultured corneal epithelial cells measured by plasminogen activator release. J Córnea Surg 1944;10:95-102.
21 Vilias-Boas ML. Ação do alil-sulfonato de sódio na câmara anterior do olho do coelho. Estudo biomicroscópico, tonométrico, citológico, histológico e de microscopia especular.SS Tese de Doutoramento apresentada ao Instituto Hilton Rocha. Aprovada com louvor 1988.