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DisCoVisc – Protective Factors In Phacoemulsification 1. Geoffrey Painter1,2,3 ¹University of Sydney Cataract Surgery Research Unit, Sydney, Australia PURPOSE: The two major roles of ocular visco-elastic devices (OVD's) in phacoemulsification are to maintain the anterior chamber and to protect the corneal endothelium. Studies have shown the endothelial protective effects of OVD's that combine chondroitin sulphate with sodium hyaluronate but also show increased removal times. DisCoVisc® is a new class of OVD's that changes characteristics at different flow rates to achieve better endothelial protection with ease of removal. This study was designed to examine these features. METHODS: The study is a single site, single surgeon, prospective, randomized and partially masked clinical trial of 180 patients comparing the space maintenance and corneal endothelial protection of DisCoVisc®, Healon® and Amvisc PLUS® in routine phacoemulsification. An independent observer graded the cataracts using the LOCS II grading system and recorded clinical observations and endothelial cell count pre-operatively, one week and one month post-operatively. The intraoperative characteristics of each OVD were graded by a questionnaire. RESULTS: Analysis showed significant differences in handling characteristics between the three OVD's. DisCoVisc® maintained the anterior chamber very well in all stages of surgery while Healon® performed below average in even routine surgery and worse in complicated cases. DisCoVisc®, as could be expected, was slower to be removed but provided excellent endothelial protection. CONCLUSION: Despite the slightly longer time to remove, DisCoVisc® had excellent space maintenance in all stages of Phacoemulsification. Healon® in this study did not perform well in this regard and would be hard to recommend for phacoemulsification. In addition DisCoVisc® provided excellent protection to the endothelium. |
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