Corneal endothelial protection by different viscoelastics during phacoemulsification

J Cataract Refract Surg. 1997 Apr;23(3):433-9. doi: 10.1016/s0886-3350(97)80190-3.


Purpose: To evaluate corneal endothelium morphology and function after phacoemulsification using different viscoelastics.

Setting: Eye Clinic, University of Trieste, Italy.

Methods: This prospective, randomized study included results of preoperative and postoperative (7, 30, and 90 days) examinations of 66 patients scheduled for phacoemulsification without ocular pathology; 8 patients were excluded. Patients were randomly assigned to one of four groups based on type of viscoelastic used: 1% sodium hyaluronate (Healon); 1.4% sodium hyaluronate (Healon GV); 4% sodium chondroitin sulfate-3% sodium hyaluronate (Viscoat); 2% hydroxypropyl methylcellulose (Hymecel). Mean cell density and cell size variation coefficient were determined by specular microscopy; central corneal thickness, by ultrasonic pachymetry; and endothelial permeability coefficient and active pump function, by anterior segment fluorophotometry.

Results: There were no significant differences in postoperative mean cell loss among the groups. The cell size variation coefficient was altered in all groups 7 days after surgery and was still impaired at 30 days in the Hymecel group. A significant increase in mean corneal thickness, endothelial permeability, and active pump function occurred in the Healon and Hymecel groups 7 days after surgery. These parameters were still altered 30 days after surgery in the Hymecel group. Endothelial functional alterations did not occur in the Healon GV or Viscoat group.

Conclusion: Viscoat and Healon GV are effective in minimizing functional damage of endothelial structure in the early medium-term postoperative period.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Cell Count
  • Cell Membrane Permeability / drug effects
  • Chondroitin / administration & dosage*
  • Chondroitin Sulfates
  • Drug Combinations
  • Endothelium, Corneal / drug effects
  • Endothelium, Corneal / metabolism
  • Endothelium, Corneal / pathology*
  • Follow-Up Studies
  • Humans
  • Hyaluronic Acid / administration & dosage*
  • Hypromellose Derivatives
  • Lenses, Intraocular
  • Methylcellulose / administration & dosage
  • Methylcellulose / analogs & derivatives*
  • Middle Aged
  • Phacoemulsification / methods*
  • Postoperative Period
  • Prospective Studies
  • Protease Inhibitors / administration & dosage


  • Drug Combinations
  • Protease Inhibitors
  • chondroitin sulfate, sodium hyaluronate drug combination
  • Hypromellose Derivatives
  • Hyaluronic Acid
  • Methylcellulose
  • Chondroitin
  • Chondroitin Sulfates