International Ophthalmology

, Volume 38, Issue 1, pp 5–10 | Cite as

Effects of phacoemulsification with versus without viscoelastic devices on surgical outcomes

  • İbrahim Taşkın
  • Lokman Aslan
Original Paper



The aim of this study is to report surgical outcomes in patients undergoing phacoemulsification surgery (PE) with versus without ophthalmic viscosurgical devices (OVDs).


This is a comparative case series study. In total, 145 patients who performed PE with OVDs in 68 eyes (Group 1) and without OVD in 77 eyes (Group 2) were enrolled. A comprehensive ophthalmological examination was performed including slit-lamp, fundus examination. Best-corrected visual acuity (BCVA), intraocular pressure (IOP) specular endothelial microscopy (SM), and ultrasound pachymetry (UP) were also measured before surgery and at four-time points postoperatively. The differences in baseline characteristics as well as in outcomes were compared between the two groups.


The mean BCVA was 0.41 ± 0.26 logMAR in Group 1 and 0.54 ± 0.34 in Group 2 at postoperative first day, with a significant difference (p < 0.01). The mean BCVA, IOP, and UP at 6 months did not differ between the groups. The mean baseline and postoperative SMs were 2063 and 1910 cells/mm2, respectively, and the endothelial cell loss (ECL) was 153.89 ± 189 in Group 1. The mean baseline and postoperative SMs were 2153 and 1948 cells/mm2, respectively, and the ECL was 205 ± 200 in Group 2. The difference between the groups was not statistically significant (p = 0.105).


The ECL seemed to be higher in the Group 2, but the difference was not significant. The final clinical outcomes were similar between the groups. In selected cases, PE without OVD may be preferable to reduce the cost of surgery in places with low economic status and to prevent side-effects of these devices.


Phacoemulsification Viscosurgical device Cornea endothelium 


  1. 1.
    Dick HB, Gerste RD, Rivera RP, Schultz T (2013) Femtosecond laser-assisted cataract surgery without ophthalmic viscosurgical devices. J Refract Surg 29:784–787CrossRefPubMedGoogle Scholar
  2. 2.
    Rosado-Adames N, Afshari NA (2012) The changing fate of the corneal endothelium in cataract surgery. Curr Opin Ophthalmol 23:3–6CrossRefPubMedGoogle Scholar
  3. 3.
    Minkovitz JB, Stark WJ (1995) Corneal complications of intraocular surgery. Curr Opin Ophthalmol 6:79–85CrossRefPubMedGoogle Scholar
  4. 4.
    Reepolmaha S, Limtrakarn W, Uthaisang-Tanechpongtamb W, Dechaumphai P (2010) Fluid temperature at the corneal endothelium during phacoemulsification: comparison of an ophthalmic viscosurgical device and balanced salt solution using the finite element method. Ophthalmic Res 43:173–178CrossRefPubMedGoogle Scholar
  5. 5.
    Van den Bruel A, Gailly J, Devriese S, Welton NJ, Shortt AJ, Vrijens F (2011) The protective effect of ophthalmic viscoelastic devices on endothelial cell loss during cataract surgery: a meta-analysis using mixed treatment comparisons. Br J Ophthalmol 95:5–10CrossRefPubMedGoogle Scholar
  6. 6.
    Hiratsuka Y, Yamada M, Murakami A et al (2011) Cost-effectiveness of cataract surgery in Japan. Jpn J Ophthalmol 55:333–342CrossRefGoogle Scholar
  7. 7.
    Dick HB, Augustin AJ, Pakula T, Pfeiffer N (2003) Endotoxins in ophthalmic viscosurgical devices. Eur J Ophthalmol 13:176–184CrossRefPubMedGoogle Scholar
  8. 8.
    Jürgens I, Matheu A, Castilla M (1997) Ocular hypertension after cataract surgery: a comparison of three surgical techniques and two viscoelastics. Ophthalmic Surg Lasers 28:30–36PubMedGoogle Scholar
  9. 9.
    Henry JC, Olander K (1996) Comparison of the effect of four viscoelastic agents on early postoperative intraocular pressure. J Cataract Refract Surg 22:960–966CrossRefPubMedGoogle Scholar
  10. 10.
    Khanna R, Pujari S, Sangwan V (2011) Cataract surgery in developing countries. Curr Opin Ophthalmol 22:10–14CrossRefPubMedGoogle Scholar
  11. 11.
    Kugu S, Erdogan G, Sahin Sevim M, Ozerturk Y (2015) A clinical comparison of safety and efficacy in phacoemulsification with versus without ophthalmic viscoelastic device. Semin Ophthalmol 30(2):96–100CrossRefPubMedGoogle Scholar
  12. 12.
    Sim BW, Amjadi S, Singh R, Bhardwaj G, Dubey R, Francis IC (2013) Assessment of adequate removal of ophthalmic viscoelastic device with irrigation/aspiration by quantifying intraocular lens ‘Judders’. Clin Exp Ophthalmol 41:450–454CrossRefPubMedGoogle Scholar
  13. 13.
    Modi SS, Davison JA, Walters T (2011) Safety, efficacy, and intraoperative characteristics of DisCoVisc and Healon ophthalmic viscosurgical devices for cataract surgery. Clin Ophthalmol 5:1381–1389CrossRefPubMedCentralPubMedGoogle Scholar
  14. 14.
    Tak H (2010) Hydroimplantation: foldable intraocular lens implantation without an ophthalmic viscosurgical device. J Cataract Refract Surg 36:377–379CrossRefPubMedGoogle Scholar
  15. 15.
    Queiros A, Peixoto-de-Matos SC, Ferrer-Blasco T, Gonzalez-Meijome JM (2010) Age-related changes of corneal endothelium in normal eyes with a non-contact specular microscope. J Emmetropia 1(2):132–139Google Scholar
  16. 16.
    Storr-Paulsen A, Jørgensen JS, Norregaard JC, Thulesen J (2014) Corneal endothelial cell changes after cataract surgery in patients on systemic sympathetic α-1a antagonist medication (tamsulosin). Acta Ophthalmol 92:359–363CrossRefPubMedGoogle Scholar
  17. 17.
    Schulze SD, Bertelmann T, Manojlovic I, Bodanowitz S, Irle S, Sekundo W (2015) Changes in corneal endothelium cell characteristics after cataract surgery with and without use of viscoelastic substances during intraocular lens implantation. Clin Ophthalmol (Auckland, NZ) 20159:2073–2080CrossRefGoogle Scholar
  18. 18.
    Unsal U, Baser G, Soyler M (2016) Intraocular lens implantation without the use of ophthalmic viscosurgical device. Int Ophthalmol Mar 14. [Epub ahead of print] PubMed PMID: 2697540Google Scholar
  19. 19.
    Kiss B, Findl O, Menapace R et al (2003) Corneal endothelial cell protection with a dispersive viscoelastic material and an irrigating solution during phacoemulsification: low-cost versus expensive combination. J Cataract Refract Surg 29:733–740CrossRefPubMedGoogle Scholar
  20. 20.
    Wessels IF, DeBarge R, Wessels DA (1998) Salvaged viscoelastic reduces irrigation frequency during cataract surgery. Ophthalmic Surg Lasers 29:688–691PubMedGoogle Scholar
  21. 21.
    Jongsareejit A, Wiriyaluppa C, Kongsap P, Phumipan S (2012) Cost-effectiveness analysis of manual small incision cataract surgery (MSICS) and phacoemulsification (PE). J Med Assoc Thai 95:212–220PubMedGoogle Scholar
  22. 22.
    Muralidhar R, Siddalinga Swamy GS, Vijayalakshmi P (2012) Completion rates of anterior and posterior continuous curvilinear capsulorhexis in pediatric cataract surgery for surgery performed by trainee surgeons with the use of a low-cost viscoelastic. Indian J Ophthalmol 60:144–146CrossRefPubMedCentralPubMedGoogle Scholar
  23. 23.
    Fang J, Wang X, Lin Z, Yan J, Yang Y, Li J (2010) Variation of cataract surgery costs in four different graded providers of China. BMC Public Health. 10:543CrossRefPubMedCentralPubMedGoogle Scholar
  24. 24.
    Gogate P (2010) Comparison of various techniques for cataract surgery, their efficacy, safety, and cost Oman. J Ophthalmol 3(3):105Google Scholar
  25. 25.
    Chandler HL, Haeussler DJ Jr, Gemensky-Metzler AJ, Wilkie DA, Lutz EA (2012) Induction of posterior capsule opacification by hyaluronic acid in an ex vivo model. Invest Ophthalmol Vis Sci 53:1835–1845CrossRefPubMedGoogle Scholar
  26. 26.
    Arshinoff S (2000) New terminology: ophthalmic viscosurgical devices. J Cataract Refract Surg 26:627–628CrossRefPubMedGoogle Scholar
  27. 27.
    Shingleton BJ, Mitrev PV (2001) Anterior chamber maintainer versus viscoelastic material for intraocular lens implantation: case-control study. J Cataract Refract Surg 27:711–714CrossRefPubMedGoogle Scholar
  28. 28.
    Waseem M, Rustam N, ul Islam Q (2007) Intraocular pressure after phacoemulsification using hydroxypropyl methylcellulose and sodium hyaluronate as viscoelastics. J Ayub Med Coll Abbottabad. 19:42–45PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2017

Authors and Affiliations

  1. 1.Ophthalmology DepartmentMaya Eye ClinicAdanaTurkey
  2. 2.Department of Ophthalmology, Faculty of MedicineKSU Kahramanmaras Sutcu Imam UniversityKahramanmarasTurkey

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