chondroitin-sulfates and Cataract

To evaluate the safety and effectiveness of a new dispersive ophthalmic viscosurgical device (OVD) (ClearVisc) compared with an approved dispersive OVD (Viscoat) when used in cataract surgery.. 16 clinics in the United States.. Prospective multicenter controlled randomized 1:1 (ClearVisc:Viscoat; stratified by site, age group, and cataract severity). Patients and examiners masked.. Patients aged 45 years or older with age-related noncomplicated cataract considered amenable to treatment with standard phacoemulsification cataract extraction and intraocular lens (IOL) implantation were included. Patients were randomized to receive either ClearVisc or Viscoat using standard techniques. 5 postoperative visits occurred at 6 hours, 24 hours, 7 days, 1 month, and 3 months. The primary effectiveness outcome was the change in endothelial cell density (ECD) from baseline to 3 months. The primary safety end point was the proportion of patients who experienced at least 1 intraocular pressure (IOP) measurement ≥30 mm Hg at any follow-up visit. Noninferiority was tested. Inflammation and adverse events were evaluated.. 372 patients were randomized: 184 patients in the ClearVisc group and 188 patients in the Viscoat group. ClearVisc was noninferior to Viscoat in mean percentage of ECD loss from baseline to 3 months (8.4% and 6.8%, respectively). ClearVisc was significantly noninferior to Viscoat in the proportion of patients with postoperative IOP ≥30 mm Hg at any follow-up visit (17.4% and 20.3%, respectively, P = .0002).. ClearVisc dispersive OVD provides surgeons with a new option in the continuum of approved dispersive OVDs with beneficial properties as a surgical aid in cataract extraction and IOL implantation.

Topics: Cataract; Chondroitin Sulfates; Drug Combinations; Endothelium, Corneal; Humans; Hyaluronic Acid; Intraocular Pressure; Lens Implantation, Intraocular; Phacoemulsification; Prospective Studies

To study the relative effects of high and low fluidic parameters on endothelial cell density (ECD), central corneal thickness (CCT), and central macular thickness (CMT) after phacoemulsification with torsional ultrasound.. Prospective, randomized clinical trial based on a tertiary eye hospital.. The study included 65 patients in each group. Patients were randomized to either the high or the low flow group using a computerized random number table. The study was patient and examiner masked. All patients underwent phacoemulsification with torsional ultrasound. Visual acuity, ECD, CCT, and CMT were measured for all patients preoperatively at 2 weeks and 6 weeks postoperatively.. The Shapiro-Wilks test was used to assess the normality of the data. Mann-Whitney U-test with the P value set at 0.05 was used to compare the two groups.. Cumulative dissipated energy was significantly higher in the low flow group (16.44 ± 9.07 vs. 11.74 ± 6.68; P = 0.002). No statistically significant difference was noted between the two groups in the ECD, CCT, CMT, or corrected distance visual acuity at the end of 6 weeks.. No significant difference was noted in the postoperative outcome between high and low flow groups. Parameters can be modified to suit the surgeon's preference, as both high and low flow parameters were found to have comparable postoperative outcomes.

Topics: Cataract; Cell Count; Chondroitin Sulfates; Corneal Pachymetry; Drug Combinations; Endothelium, Corneal; Female; Follow-Up Studies; Humans; Hyaluronic Acid; Iris; Macula Lutea; Male; Middle Aged; Phacoemulsification; Postoperative Complications; Prospective Studies; Therapeutic Irrigation; Tomography, Optical Coherence; Treatment Outcome; Ultrasonic Therapy; Visual Acuity

To evaluate the effect of Viscoat (sodium chondroitin sulfate 4%-sodium hyaluronate 3%) and DuoVisc (Viscoat and Provisc [sodium hyaluronate 1%]) on postoperative intraocular pressure (IOP) after bilateral small-incision cataract surgery.. Department of Ophthalmology, University of Vienna, Vienna, Austria.. This prospective randomized study comprised 60 eyes of 30 consecutive patients with age-related cataract in both eyes. Each patient's eyes were randomly assigned to receive Viscoat or DuoVisc during cataract surgery. DuoVisc is a packet containing 2 ophthalmic viscosurgical devices (OVDs): the dispersive Viscoat, which was used for intraocular lens (IOL) implantation. In the Viscoat group, the Viscoat was used during the entire surgery. The intraocular pressure (IOP) was measured preoperatively as well as 1, 6, and 20 to 24 hours postoperatively.. One and 6 hours postoperatively, the mean IOP was significantly higher in the Viscoat group than in the DuoVisc group (25.8 mm Hg and 20.5 mm Hg, respectively, at 1 hour and 24.7 mm Hg and 21.1 mm Hg, respectively, at 6 hours) (P<.05). At 20 to 24 hours, the mean IOP was not statistically significantly different between the 2 groups. Intraocular pressure spikes to 30 mm Hg or higher occurred in 4 eyes in the DuoVisc group and 11 eyes in the Viscoat group (P<.05).. Viscoat caused significantly higher IOP increases and significantly more IOP spikes than DuoVisc in the early postoperative period. Therefore, if Viscoat is used during cataract surgery, an additional cohesive OVD should be used for IOL implantation.

Topics: Aged; Aged, 80 and over; Capsulorhexis; Cataract; Chondroitin; Chondroitin Sulfates; Drug Combinations; Female; Humans; Hyaluronic Acid; Intraocular Pressure; Lens Implantation, Intraocular; Male; Microsurgery; Middle Aged; Phacoemulsification; Postoperative Period; Prospective Studies; Tonometry, Ocular

To evaluate the protective ability of the soft-shell technique in patients with senile cataract and Fuchs' dystrophy having phacoemulsification with intraocular lens (IOL) implantation.. Department of Ophthalmology, Railway Hospital, Katowice, Poland.. Sixty-one eyes of 54 patients (37 women, 17 men) with clinically confirmed Fuchs' dystrophy and cataract had clear corneal phacoemulsification and implantation of an intracapsular posterior chamber IOL with sodium hyaluronate 1% (Healon) or chondroitin sulfate 4%-sodium hyaluronate 3% (Viscoat) in combination with sodium hyaluronate 1% (Provisc) in 1 package (DuoVisc). The central corneal thickness (CCT), measured with a Pocket Precision ultrasonic pachymeter (Quantel Medical, Inc.), was compared preoperatively and 1 day, 1 week, and 1 and 6 months postoperatively.. The mean preoperative CCT was 549.5 microm +/- 29.3 (SD). The postoperative increase in CCT over preoperative pachymetry measurements remained statistically significant in both ophthalmic viscosurgical device groups throughout the entire follow-up, from the first day to the sixth month after surgery (P<.0001). The maximum increase in CCT in both groups was on the first postoperative day, and it was significantly higher in the Healon group. Six months postoperatively, patients in the Healon group had a significantly greater CCT increase (P = .008).. The soft-shell technique effectively protected the compromised endothelium in patients with Fuchs' dystrophy, proving its advantages in eyes with moderately damaged endothelium.

Topics: Aged; Cataract; Cell Count; Chondroitin Sulfates; Corneal Diseases; Drug Therapy, Combination; Endothelium, Corneal; Female; Fuchs' Endothelial Dystrophy; Humans; Hyaluronic Acid; Lens Implantation, Intraocular; Lenses, Intraocular; Male; Phacoemulsification; Prospective Studies

To introduce a case of iridoschisis patient who underwent cataract surgery successfully without pupil device.. A 64-year-old female who showed iridoschisis of her both eyes underwent cataract operation at her right eye without a pupillary device. The preoperative and postoperative ophthalmologic examinations including visual acuity, intraocular pressure, reaction of anterior chamber, and degree of damage on iris was evaluated respectively.. Cataract surgery was performed under topical anesthesia through a clear corneal incision. Iris fibrils were held in place by ophthalmic viscosurgical device (OVD, sodium hyaluronate 3%-sodium chondroitin sulfate 4%, Viscoat) that was injected into the anterior chamber. A small capsulorrhexis was made and the nucleus was delivered with low-power phacoemulsification, most of which was performed under the anterior capsule. The iris came into contact with the OVDs only and received no mechanical trauma. There were no intraoperative complications such as tear of the iris, hyphema, loss of mydriasis, or rupture of the posterior lens capsule. The edema of corneal stroma and inflammation of anterior chamber was shown at immediate-postoperative period, but completely subsided 2 weeks later. The visual acuity showed improvement from 20/400 to 20/30.. In iridoschisis patients, there is a risk of aspiration of iris fibers during cataract surgery. With adequate use of OVD and careful modulation of surgical devices, cataract surgery was successfully performed without using extra pupil-supporting device.

Topics: Anesthesia, Local; Cataract; Chondroitin; Chondroitin Sulfates; Drug Combinations; Female; Humans; Hyaluronic Acid; Iris Diseases; Lens Implantation, Intraocular; Middle Aged; Phacoemulsification; Visual Acuity

To evaluate whether the soft-shell technique using Viscoat (sodium hyaluronate 3%-chondroitin sulfate 4%) and Hyal-2000 (sodium hyaluronate 1%) reduces corneal endothelial cell damage during cataract surgery.. Department of Ophthalmology, Kangnam St. Mary's Hospital, Seoul, Korea.. The nuclear opacity in 252 eyes of 230 cataract patients was classified as grade 1, 2, 3, or > or =4 using the Lens Opacities Classification System III. In each classification, the patients were divided into 4 groups before phacoemulsification based on the type of ophthalmic viscosurgical device (OVD) used during surgery: Viscoat and Hyal-2000 (soft-shell technique), Viscoat alone, Hyal-2000 alone, or Provisc (sodium hyaluronate 1%) alone. All patients were operated on using the same technique except for the OVD. The visual acuity, corneal endothelial cell density, corneal thickness, and intraocular pressure (IOP) were evaluated postoperatively.. The rate of endothelial cell loss 2 months after surgery in eyes with a nuclear opacity grade of > or =4 was significantly different between the 4 OVD groups. The rate in eyes with a nuclear opacity grade of < or =3 was not significantly different between the groups. There were no statistically significant differences between the 4 groups in visual acuity, corneal thickness, or IOP throughout the follow-up period.. The soft-shell technique using Viscoat and Hyal-2000 protected corneal endothelial cells during cataract surgery in patients with a nuclear opacity grade of > or =4.

Topics: Aged; Cataract; Cell Count; Chondroitin; Chondroitin Sulfates; Drug Combinations; Drug Therapy, Combination; Endothelium, Corneal; Female; Humans; Hyaluronic Acid; Intraoperative Complications; Lens Implantation, Intraocular; Male; Middle Aged; Phacoemulsification; Prospective Studies; Treatment Outcome

We determined the types and distribution of glycosaminoglycans (GAGs) and collagens, in anterior capsular opacification after endocapsular phacoemulsification and aspiration (ECPEA) and intraocular lens implantation.. Opacified anterior capsules were removed from human eyes after ECPEA. Immunohistochemical staining was performed to determine GAGs with monoclonal antibodies to chondroitin, chondroitin-4-sulfate (C4S), chondroitin-6-sulfate (C6S), dermatan sulfate (DS), and keratan sulfate (KS); collagens with monoclonal antibodies to types I, II, and III collagens; and cellular characteristics with monoclonal antibodies to vimentin, desmin, alpha-smooth muscle actin, and cytokeratin. Decorin mRNA and type I collagen mRNA were detected by in situ hybridization.. In the capsules, the C6S, DS, KS, and types I and III collagens were similar to the chemical components found at the adhesion site of the anterior and posterior capsules after extracapsular cataract extraction, and cellular components contained vimentin, desmin, alpha-smooth muscle actin, cytokeratin, decorin mRNA, and type I collagen mRNA.. The GAGs and collagens in opacified anterior capsule after ECPEA were similar to those found during wound healing, although KS is present in normal anterior segment tissue during development and only in the cornea postnatally. These chemical components may be produced by myofibroblast-like cells presumably transformed from lens epithelial cells.

Topics: Aged; Cataract; Chondroitin Sulfates; Collagen; Dermatan Sulfate; Extracellular Matrix; Extracellular Matrix Proteins; Humans; Immunohistochemistry; In Situ Hybridization; Intermediate Filament Proteins; Keratan Sulfate; Lens Capsule, Crystalline; Lens Implantation, Intraocular; Middle Aged; Phacoemulsification; RNA, Messenger

To investigate the chemical pathology in the blood and lens, in cases of congenital or infantile cataract in children excreting predominantly non-reducing carbohydrates in urine.. Urine samples from children with congenital or infantile cataract, and age and sex-matched controls, were analysed for (i) inherited errors of metabolism, (ii) paper chromatography of sugars, (iii) spectrophotometric assay of glycosaminoglycans (GAG), (iv) cetyl trimethyl ammonium bromide test, (v) electrophoresis using Alcian blue, (vi) ion exchange chromatography with IR 120 resin, and (vii) HPLC for xylose. Blood and lens material were also tested for GAG fragments and xylose. beta Glucuronidase was assayed in lymphocytes and urine.. Of 220 children of both sexes below 12 years of age, with congenital or infantile cataract treated in Sankara Nethralaya, Madras, India, during a period of 2 years, 145 excreted fragments of GAG (heparan and chondroitin sulphates) in their urine. There was no such excretion among the control group of 50 children. The same was found accumulated in the blood and lenses of affected children. In addition, xylose was present in small amounts in the urine and blood and xylitol was present in the lens. There was a significant elevation in the activity of beta glucuronidase in lymphocytes and urine, when compared with normals. All the above findings suggest deranged proteoglycan metabolism. As the urine contained mostly GAG fragments and very little xylose, Benedict's reagent was not reduced. This ruled out galactosaemia.. An increase of beta glucuronidase activity might have caused extensive fragmentation of GAG with resultant accumulation in the blood and lens and excretion in urine. Small amounts of xylose may have come from xylose links between GAG and core protein of proteoglycans. Owing to their polyanionic nature, GAG fragments in the lens might abstract sodium, and with it water, thereby increasing the hydration of the lens. Excessive hydration and the osmotic effect of xylitol from xylose might cause cataract. While corneal clouding has been reported in inborn acid mucopolysaccharidosis, congenital or infantile cataract with deranged metabolism of proteoglycans (acid mucopolysaccharide-xylose-protein complex) is reported in children for the first time.

Topics: Case-Control Studies; Cataract; Child; Child, Preschool; Chondroitin Sulfates; Chromatography; Female; Heparitin Sulfate; Humans; Infant; Infant, Newborn; Lens, Crystalline; Male; Proteoglycans; Spectrophotometry; Xylose

The iris of patients with exfoliation syndrome and senile cataracts were studied with a polarization microscope as well as histochemically. Amorphous substance stained by pH 1.0 alcian blue was observed in exfoliation syndrome on the posterior surface of the iris. This layer was thicker in exfoliation syndrome than in senile cataracts. The major component of this layer was verified as chondroitin sulphate and the minor one as hyaluronic acid. Polarization microscopic study demonstrated the presence of more sulphated glycosaminoglycans in exfoliation syndrome than in senile cataracts. Abnormal metabolism of glycosaminoglycans is indicated in the iris of exfoliation syndrome.

Topics: Aged; Cataract; Chondroitin Sulfates; Female; Glycosaminoglycans; Histocytochemistry; Humans; Hyaluronic Acid; Iris; Iris Diseases; Male; Microscopy, Polarization; Middle Aged; Syndrome