Corneal endothelial cell protection with a dispersive viscoelastic material and an irrigating solution during phacoemulsification: low-cost versus expensive combination

J Cataract Refract Surg. 2003 Apr;29(4):733-40. doi: 10.1016/s0886-3350(02)01745-5.


Purpose: To evaluate the protective effect on corneal endothelial cells of a low-cost and an expensive combination of a dispersive viscoelastic material and an irrigating solution during phacoemulsification.

Setting: Department of Ophthalmology, University of Vienna, Vienna, Austria.

Methods: This prospective randomized examiner- and patient-masked study comprised 90 eyes of 45 consecutive patients with age-related cataract in both eyes. For each patient, the first eye was randomly assigned to receive hydroxypropyl methylcellulose 2% (Ocucoat) and Ringer's solution (low-cost combination) or sodium chondroitin sulfate 4%-sodium hyaluronate 3% (Viscoat) and an enriched balanced salt solution (BSS Plus) (expensive combination) during phacoemulsification. The contralateral eye received the other treatment. Endothelial cell function was evaluated by measuring corneal thickness (CT) using partial coherence interferometry, morphology assessment, and endothelial cell counts.

Results: The acute postoperative increase in CT was +9.8 microm in the low-cost group and +10.9 microm in the expensive group; the difference between groups was not significant. After 1 month, the CT still differed significantly from baseline in the low-cost group. Three months after surgery, the CT had returned to baseline values in both groups. There was no significant between-group difference in endothelial cell counts or morphology.

Conclusions: During phacoemulsification in a nonselected patient population, there was no difference in acute postoperative corneal edema and endothelial cell morphology after 3 months between a Viscoat and BSS Plus combination and an Ocucoat and Ringer's solution combination. Eyes receiving the expensive combination had marginally faster recovery of corneal swelling by 3 months. However, the cost of Viscoat and 500 mL BSS Plus is 5 times that of Ocucoat and Ringer's solution.

Publication types

  • Clinical Trial
  • Comparative Study
  • Evaluation Study
  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Aged, 80 and over
  • Bicarbonates / economics
  • Bicarbonates / therapeutic use*
  • Cell Count
  • Chondroitin / economics
  • Chondroitin / therapeutic use*
  • Chondroitin Sulfates
  • Corneal Edema / economics
  • Corneal Edema / etiology
  • Corneal Edema / prevention & control*
  • Cytoprotection / drug effects
  • Double-Blind Method
  • Drug Combinations
  • Drug Costs
  • Drug Therapy, Combination
  • Endothelium, Corneal / drug effects*
  • Endothelium, Corneal / pathology
  • Glutathione / economics
  • Glutathione / therapeutic use*
  • Humans
  • Hyaluronic Acid / economics
  • Hyaluronic Acid / therapeutic use*
  • Hypromellose Derivatives
  • Isotonic Solutions / economics
  • Isotonic Solutions / therapeutic use*
  • Methylcellulose / analogs & derivatives*
  • Methylcellulose / economics
  • Methylcellulose / therapeutic use*
  • Middle Aged
  • Ophthalmic Solutions / economics
  • Ophthalmic Solutions / therapeutic use
  • Phacoemulsification / adverse effects*
  • Phacoemulsification / economics
  • Prospective Studies
  • Ringer's Solution


  • Bicarbonates
  • Drug Combinations
  • Isotonic Solutions
  • Ophthalmic Solutions
  • chondroitin sulfate, sodium hyaluronate drug combination
  • glutathione-bicarbonate-Ringer solution
  • Hypromellose Derivatives
  • Ringer's Solution
  • Hyaluronic Acid
  • Methylcellulose
  • Chondroitin
  • Chondroitin Sulfates
  • Glutathione