chondroitin and Corneal-Diseases

To compare the ability of Healon GV (sodium hyaluronate 1.4%) and Viscoat (sodium chondroitin sulfate 4.0%-sodium hyaluronate 3.0%) to protect the corneal endothelium during endocapsular phacoemulsification and foldable intraocular lens (IOL) implantation.. A small ophthalmology group practice.. One hundred forty patients were randomized, 70 per group, in a prospective, partially masked study of cataract surgery using Healon GV or Viscoat. One ophthalmologist performed all surgery. Primary outcome variables were the 2 week postoperative changes in corneal thickness, endothelial cell density, mean endothelial cell size, and endothelial cell hexagonality. Several secondary variables were measured, and an analysis of the statistical power of the study was performed.. There were no statistically significant differences between groups in terms of age (P = .856), cataract density (P = .117), preoperative best corrected visual acuity (BCVA) (P = .892), postoperative BCVA (P = .969), amount of viscoelastic material used during surgery (P = .444), amount of irrigating solution used (P = .125), or phacoemulsification time (P = .088). It took longer to remove the Viscoat than the Healon GV (P < .001), and total operating time for the Viscoat group was longer (P < .001). Two weeks after surgery, there were no significant differences between groups in corneal thickness (P = .362), endothelial cell density (P = .351), or mean endothelial cell size (P = .610). However, Viscoat preserved the hexagonal shape of endothelial cells slightly better than Healon GV (P = .043). The study had sufficient power to detect clinically significant differences in corneal thickness, endothelial cell density, and endothelial cell size.. Healon GV and Viscoat were comparable in their ability to protect the corneal endothelium during endocapsular phacoemulsification and foldable IOL implantation. Results may vary, however, if phacoemulsification is performed anterior to the iris plane.

Topics: Aged; Anesthesia, Local; Cell Count; Cell Size; Chondroitin; Chondroitin Sulfates; Corneal Diseases; Drug Combinations; Endothelium, Corneal; Humans; Hyaluronic Acid; Lens Implantation, Intraocular; Lenses, Intraocular; Phacoemulsification; Prospective Studies; Single-Blind Method; Treatment Outcome; Visual Acuity

To determine the influence of dispersive ophthalmic viscosurgical products (OVPs) on corneal endothelial cell (CEC) density during penetrating keratoplasty (PKP) and on the postoperative intraocular pressure (IOP).. In 117 eyes of 113 patients, PKP was performed by a single surgeon from April 1, 1998 to April 30, 2002. Loss of CECs and postoperative IOP were evaluated retrospectively after use of Viscoat (sodium hyaluronate 3.0%, chondroitin sulfate 4.0%) plus Healon (sodium hyaluronate 1.0%) (Viscoat/Healon group) or Healon alone (Healon group) during surgery.. The average CEC loss was 14.6 +/- 15.5% and 9.0 +/- 10.5% at 1 month, 18.1 +/- 14.6% and 10.1 +/- 7.3% at 3 months, 20.1 +/- 16.3% and 12.2 +/- 10.9% at 6 months, and 31.7 +/- 21.4% and 18.1 +/- 15.5% at 12 months in the Healon (n = 74) and Viscoat/Healon (n = 43) groups, respectively. Patients were stratified into groups with corneal leukoma (n = 61) or bullous keratopathy (n = 56). Loss of CECs was significantly smaller in the Viscoat/Healon group compared with the Healon group irrespective of whether patients had corneal leukoma or bullous keratopathy at 3, 6, and 12 months postoperatively. There was no significant difference of postoperative IOP between the Healon and Viscoat/Healon groups over 12 months of follow-up.. These results suggest that the addition of Viscoat to Healon decreases CEC loss during PKP and does not affect postoperative IOP.

Topics: Adjuvants, Immunologic; Adult; Aged; Aged, 80 and over; Cell Count; Chondroitin; Chondroitin Sulfates; Corneal Diseases; Drug Combinations; Drug Therapy, Combination; Endothelium, Corneal; Female; Follow-Up Studies; Graft Rejection; Humans; Hyaluronic Acid; Intraocular Pressure; Male; Middle Aged; Postoperative Period; Retrospective Studies; Time Factors; Treatment Outcome

A patient developed an acute onset of pseudophakic bullous keratopathy and a diffuse, gray, subepithelial corneal deposit ten days following surgery during which sodium chondroitin sulfate was used. The deposit, identified histologically as calcium, was noted throughout Bowman's layer. The absence of chronic pathologic features in the posterior cornea eliminated Fuchs' endothelial dystrophy as the cause of the acute corneal decompensation. This histopathologic confirmation of calcium deposition with one formulation of chondroitin sulfate, combined with similar conclusions from previous case reports, stimulated the reformulation of the product, which has been shown to be useful in clinical practice.

Topics: Aged; Calcinosis; Cataract Extraction; Chondroitin; Cornea; Corneal Diseases; Corneal Opacity; Corneal Transplantation; Female; Humans; Lenses, Intraocular; Postoperative Complications

Band keratopathy developed rapidly in two patients following uneventful phacoemulsification and intraocular lens implantation using BSS Plus (balanced salt solution enriched with glutathione, bicarbonate, and glucose) infusion and Viscoat (chondroitin sulfate-sodium hyaluronate), which was left in the anterior chamber at the conclusion of the procedure. Histopathologic evaluation of corneal tissue obtained from one patient at the time of edetic acid chelation revealed histochemical findings consistent with anterior stromal calcification. To investigate a possible relationship between Viscoat and the rapid onset of band keratopathy, Viscoat formulated with varying concentrations of phosphate buffer was injected intracamerally into 42 rabbit eyes. Within 48 hours, clinically obvious corneal opacification developed in nine (47%) of 19 eyes injected with the commercial preparation of Viscoat. Also, similar opacification developed in ten (77%) of 13 eyes that received Viscoat formulated with twice the phosphate concentration of the commercial preparation. Band keratopathy did not develop any of ten eyes that received Viscoat with one fourth the commercial phosphate concentration. In selected opacified corneas, the presence of phosphorus in the subepithelial and posterior corneal stroma was confirmed by histochemical stains and energy-dispersive x-ray analysis.

Topics: Aged; Aged, 80 and over; Animals; Anterior Chamber; Calcinosis; Chondroitin; Chondroitin Sulfates; Corneal Diseases; Drug Combinations; Female; Humans; Hyaluronic Acid; Instillation, Drug; Male; Rabbits

Topics: Calcinosis; Cataract Extraction; Chondroitin; Cornea; Corneal Diseases; Epithelium; Humans; Lenses, Intraocular; Postoperative Complications

An intraocular-lens abrasion test, vital dye staining, and scanning electron microscopy were used for an in vitro comparison of endothelial protection offered by four viscous solutions of 1% sodium hyaluronate (Healon), 3% sodium hyaluronate (AmVisc), 4% chondroitin sulfate (Viscoat), and 2% methylcellulose. Wide-field specular microscopy with analysis of endothelial cell density and morphologic evaluation, pachymetry, and intraocular pressure measurements were also used to study the toxicity of the viscous solutions in an in vivo cat model with and without anterior chamber washout. All four solutions provided complete endothelial protection from mechanical trauma. Endothelial cell density and morphologic nature were unaffected during the in vivo toxicity study. A mild increase in intraocular inflammation occurred at one and two days after intraocular injection with all four viscous solutions. Intraocular pressure elevations peaked within four hours after instillation of the viscous solutions and were significantly reduced by anterior chamber washout.

Topics: Animals; Anterior Chamber; Cats; Chondroitin; Chondroitin Sulfates; Corneal Diseases; Drug Combinations; Endothelium; Hyaluronic Acid; Intraocular Pressure

K-Sol, a new cornea preserving solution which contains no calf serum of foreign protein and is used for refrigerated storage of donor tissue, has storage procedures identical to those currently used for tissue preservation in McCarey-Kaufman medium. K-Sol can keep corneas alive and usable for penetrating keratoplasty for at least two weeks. The clinical results in a series of 17 patients indicated that tissue preserved in K-Sol for as long as two weeks, even when used by inexperienced surgeons in difficult or unfavorable cases requiring extensive anterior segment reconstruction, including reoperations or retained intraocular lenses, gave results virtually identical to those obtained with tissue preserved in McCarey-Kaufman medium for only two or three days.

Topics: Adult; Aged; Chondroitin; Chondroitin Sulfates; Cornea; Corneal Diseases; Corneal Transplantation; Endothelium; Freezing; Humans; Microscopy, Electron; Middle Aged; Mitochondria; Solutions; Tissue Donors; Tissue Preservation; Vitrectomy

Topics: Anterior Chamber; Chondroitin; Chondroitin Sulfates; Corneal Diseases; Humans

A case of corneal graft operation using chondroitin sulphate (CDS-TM) to protect the endothelium, highlights the surgical difficulties encountered as a result of the severe dehydration effects on the donor corneal button produced by the CDS. In vitro experiments comparing Healonid and CDS on 8 mm excised donor corneal buttons from three pairs of human eyes, confirms this effect with CDS which was absent with Healonid.

Topics: Adult; Aged; Chondroitin; Chondroitin Sulfates; Cornea; Corneal Diseases; Corneal Transplantation; Dehydration; Female; Humans; Hyaluronic Acid; In Vitro Techniques; Male

Topics: Chondroitin; Contact Lenses; Cornea; Corneal Diseases; Corneal Injuries; Humans