methylcellulose and Postoperative-Complications

To describe a patient with scleral dellen after pterygium excision with intraoperative mitomycin C.. Case report and MEDLINE review of the medical literature on scleral dellen after bare sclera technique.. A 48-year-old man had a left nasal pterygium excised by the bare sclera technique with intraoperative mitomycin C. Eight days after surgery, the patient noticed a small black spot in the bare sclera area with mild irritation. Slit-lamp examination revealed a focal area of extreme thinning, centered on the nonepithelialized bare sclera, surrounded by edematous conjunctiva. The ciliary body was visible through the thin and dry scleral lesion. After topical lubricant therapy, the scleral lesion appeared normal thickness and white in color 3 days later. Therapy was continued until the sclera epithelialized.. Scleral dellen is an early postoperative complication of bare sclera technique owing to delayed conjunctival wound closure. Hydration of the thinned sclera will rapidly thicken it. However, medical therapy should be continued until the surrounding conjunctiva has flattened and the sclera has epithelialized. Surgical wound closure is an alternative management and may be the way to prevent scleral dellen formation after bare sclera technique. All patients after bare sclera surgery should be followed up until the conjunctival wound has healed. If delayed healing is found, frequent artificial tears, patching, or surgical intervention is necessary.

Topics: Acute Disease; Humans; Intraoperative Period; Lactose; Lubrication; Male; Methylcellulose; Middle Aged; Mitomycin; Ophthalmologic Surgical Procedures; Oxazines; Postoperative Complications; Pterygium; Sclera; Scleral Diseases; Wound Healing

Adhesive bowel obstruction is one of the most frequent complications after radical cystectomy, prolonging hospital stay and fasting period and increasing medical expenses. This study evaluated the effectiveness of hyaluronic acid/carboxymethylcellulose (HA/CMC) in preventing adhesive bowel obstruction after laparoscopic radical cystectomy.. Randomized, controlled, single-blinded study was performed. Of 76 patients who underwent laparoscopic radical cystectomy for bladder cancer, 38 received HA/CMC instillation and 38 did not. The primary endpoint was the rate of postoperative adhesive bowel obstruction. The secondary endpoint was the rate of other postoperative outcomes.. None of the patients who received HA/CMC instillation experienced postoperative adhesive bowel obstructions, compared with six (15.79%) patients in the control group (p = 0.025). Of the six patients with ileus, two underwent adhesiolysis. There were no significant differences between the two groups in other postoperative outcomes.. HA/CMC instillation during laparoscopic radical cystectomy may reduce the incidence of postoperative adhesive bowel obstruction without adverse effects.

Topics: Aged; Cystectomy; Female; Humans; Hyaluronic Acid; Intestinal Obstruction; Intraoperative Care; Laparoscopy; Male; Methylcellulose; Postoperative Complications; Single-Blind Method; Treatment Outcome; Urinary Bladder Neoplasms

Despite the use of modern methods of prevention, at least 10% of patients operated on for ophthalmic indications not develop corneal erosion as the indirect complication of general anesthesia.. To reduce the number of ophthalmic complications of general anesthesia by prophylactic use of new mito- chondria-targeted antioxidants - Vizomitin (eye drops).. 70 patients, which was supposed to perform the average duration of operations under general anesthesia were randomized into 3 groups depending on the method specific (pharmacological) prevention of corneal erosions: (1) control (specic (pharmacological) prevention was not carried out), (2), using preparation "natural tear, and (3) "Vizomitin" preparation. Postoperative biomicroscopy was performed to assess the condition of the cornea, tear film stability was measured and the height of the tear meniscus.. When using eye drops "Vizomitin" value is an indicator of stability of the tear film on the 3rd day after the operation more than in the control group of patients by 51% (p = 0.012) and patients groups, natural tear by 57% (p = 0.013). Surgical interventions performed under general anesthesia, leading to an increase in the number ofpatients with decreased tear meniscus height index of the control group with 4 to 7 patients (p = 0.30) in the group of natural tear from 3 to 11 patients (p = 0.008) . In the group with drug "Vizomitin" the number of such patients is reduced from 7 to 1 (p = 0.018).. In the surgical procedures under general anesthesia eye drops "Vizomitin" effectively prevents the devel- opment of corneal erosion.

Topics: Adult; Anesthesia, General; Antioxidants; Benzalkonium Compounds; Cornea; Drug Combinations; Dry Eye Syndromes; Humans; Lubricant Eye Drops; Methylcellulose; Middle Aged; Mitochondria; Plastoquinone; Postoperative Complications; Treatment Outcome; Young Adult

Submucosal injection of a viscoelastic solution prolongs submucosal lift, thus, facilitating endoscopic mucosal resection. Our objective was to assess the safety and clinical effectiveness of 0.4% hydroxypropyl methylcellulose (HPMC) as a submucosal injectant for endoscopic mucosal resection.. A prospective, open-label, multicenter, phase 2 study was conducted at 2 academic institutions in Brazil. Eligible participants included patients with early gastrointestinal tumors larger than 10 mm. Outcomes evaluated included complete resection rates, volume of HPMC injected, duration of the submucosal cushion as assessed visually, histology of the resected leisons, and complication rates.. Over a 12-month period, 36 eligible patients with superficial neoplastic lesions (stomach 14, colon 11, rectum 5, esophagus 3, duodenum 3) were prospectively enrolled in the study. The mean size of the resected specimen was 20.4 mm (10 to 60 mm). The mean volume of 0.4% HPMC injected was 10.7 mL (range 4 to 35 mL). The mean duration of the submucosal fluid cushion was 27 minutes (range 9 to 70 min). Complete resection was successfully completed in 89%. Five patients (14%) developed immediate bleeding requiring endoclip and APC application. Esophageal perforation occurred in 1 patient requiring surgical intervention. There were no local or systemic adverse events related to HPMC use over the follow-up period (mean 2.2 mo).. HPMC solution (0.4%) provides an effective submucosal fluid cushion and is safe for endoscopic resection of early gastrointestinal neoplastic lesions.

Topics: Adult; Aged; Aged, 80 and over; Brazil; Endoscopy, Gastrointestinal; Esophageal Perforation; Female; Follow-Up Studies; Gastric Mucosa; Gastrointestinal Neoplasms; Humans; Hypromellose Derivatives; Intestinal Mucosa; Male; Methylcellulose; Middle Aged; Postoperative Complications; Prospective Studies; Time Factors; Treatment Outcome

To evaluate the effects of the dispersive viscoelastic agents Ocucoat (hydroxypropyl methylcellulose 2%) and Viscoat (sodium chondroitin sulphate 4%-sodium hyaluronate 3%) on postoperative intraocular pressure (IOP) after bilateral small incision cataract surgery.. This prospective, randomised study comprised 80 eyes of 40 consecutive patients with age related cataract in both eyes scheduled for bilateral small incision cataract surgery. The patients were randomly assigned to receive Ocucoat or Viscoat during cataract surgery of the first eye. The second eye was operated later and received the other viscoelastic agent. Cataract surgery was performed with a temporal 3.2 mm sutureless posterior limbal incision, phacoemulsification, and implantation of a foldable silicone intraocular lens. The IOP was measured preoperatively as well as 6 hours, 20-24 hours, and 1 week postoperatively.. At 6 hours after surgery the mean IOP increased by 4.6 (SD 5.1) mm Hg in the Ocucoat group (p<0.001) and by 8.6 (8.1) mm Hg in the Viscoat group (p<0.001). The increase was significantly higher in the Viscoat group than in the Ocucoat group (p=0.004). Intraocular pressure spikes of 30 mm Hg or more occurred in two eyes in the Ocucoat and in nine eyes in the Viscoat group (p=0.023); 20-24 hours and 1 week postoperatively the mean IOP was not statistically different.. These findings indicate that Viscoat causes a significantly higher IOP increase and significantly more IOP spikes than Ocucoat in the early period after small incision cataract surgery.

Topics: Aged; Aged, 80 and over; Chondroitin; Chondroitin Sulfates; Double-Blind Method; Drug Combinations; Female; Humans; Hyaluronic Acid; Hypromellose Derivatives; Intraoperative Care; Male; Methylcellulose; Middle Aged; Ocular Hypertension; Phacoemulsification; Postoperative Complications; Postoperative Period; Prospective Studies; Viscosity

By using three different viscoelastics [Adatocel (methylhydroxypropylcellulose), Amvisc Plus (sodium hyaluronate) and Healon (sodium hyaluronate)] a prospective randomized study was conducted to investigate whether postoperative intraocular pressure shows significant differences according to the viscoelastics used after 150 cases of cataract surgery.. The inclusion criteria for this study were: extracapsular cataract extraction via the usual small-incision techniques and endocapsular posterior-chamber lens implantation. A total of 150 eyes were operated upon. The patients were randomly assigned to three groups according to the viscoelastics, 50 cases used adatocel, 50 Amvisc Plus and 50 Healon. As far as possible, the viscoelastics were sucked out under visual control. Intraocular pressure (IOP) was measured after 6 and 24 h.. Six hours postoperatively, no statistically significant difference between the intraocular pressure after using different viscoelastics (adatocel: 19.6 +/- 9.7 mmHg, Amvisc Plus: 20.5 +/- 9.6 mmHg und Healon: 21.8 +/- 8.8 mmHg) was seen. At 24 h IOP was statistically significant higher for Healon than for adatocel and Amvisc Plus (adatocel: 16.3 +/- 4.8 mmHg, Amvisc Plus: 16.5 +/- 4.6 mmHg and Healon: 19.7 +/- 6.6 mmHg).. Six hours postoperatively after phacoemulsification there was no significant difference between the IOP using different viscoelastics adatocel, Amvisc Plus and Healon. Twenty-four hours postoperatively a significantly higher intraocular pressure was measured for Healon than for the other viscoelastics.

Topics: Adjuvants, Immunologic; Adult; Aged; Aged, 80 and over; Female; Hemostatics; Humans; Hyaluronic Acid; Hypromellose Derivatives; Intraocular Pressure; Lenses, Intraocular; Male; Methylcellulose; Middle Aged; Phacoemulsification; Postoperative Complications; Prospective Studies

Sixty eyes with age-related cataract underwent extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens (PC-IOL) implantation under similar conditions using hydroxypropyl methylcellulose (HPMC) (Oculose) (n = 20), sodium hyaluronate (Healon) (n = 20), or hyaluronic acid (IAL) (n = 20) as the viscoelastic (VE). Postoperative evaluation was performed for intraocular pressure (IOP), corneal thickness, and anterior chamber reaction at 6, 24, 48, 72 hours, and 10 days. Statistically-significant rises in IOP with IAL and Healon were observed at 6 and 24 hours; no such rises were observed with Oculose (P < .05). Seven eyes in the IAL group and six in the Healon group had IOPs greater than 22 mm Hg at 6 hours (range: 22 to 38 mm Hg and 22 to 28 mm Hg, respectively). A significant increase in average corneal thickness was observed in all of the 60 patients at 6 hours (18.5%). The average thickness decreased to 6.8% by day 10, with no intergroup variations. There were significantly fewer anterior chamber cells at 6 hours in the Healon group. We conclude that all three viscoelastics are equally useful for routine ECCE with PC-IOL implantation. However, IAL and Healon do cause an early postoperative IOP increase, which, though transient, should be treated.

Topics: Anterior Chamber; Cataract Extraction; Humans; Hyaluronic Acid; Hypromellose Derivatives; Intraocular Pressure; Lenses, Intraocular; Methylcellulose; Ocular Hypertension; Postoperative Complications; Single-Blind Method

In three prospectively randomized groups of patients viscoelastic materials during IOL-implantation have been compared concerning 1. intraocular pressure, 2. endothelial cell count, 3. corneal thickness. Examinations were performed preoperatively, the first, second and fifth postoperative day. There was no statistical difference between hydroxypropylmethylcellulose (2%), hyaluronic acid (1%) and air. Examinations were performed preoperatively the first, the second and the fifth postoperative day. There was no statistically significant difference between all groups of patients, Advantages and disadvantages for routine use of viscoelastic substances are discussed.

Topics: Corneal Stroma; Endothelium, Corneal; Foreign-Body Reaction; Humans; Hyaluronic Acid; Hypromellose Derivatives; Intraocular Pressure; Lenses, Intraocular; Methylcellulose; Postoperative Complications; Prospective Studies

Viscoelastic substances in correlation with intraocular hypotony have gained great significance in low-irritation cataract surgery within the last few years. The differences in their chemical properties, and thus in their effect on the eye, formed the grounds for a controlled clinical study comparing sodium hyaluronic acid, representing the group of glucosamine glykanes, and hydroxypropylmethyl cellulose (HPMC), representing the group of cellulose ethers. Two hundred cataract patients, excluding those suffering from diabetes mellitus, glaucoma and severe corneal damage, were examined on the 1st, 2nd and 5th postoperative day, as well as 4 weeks postoperatively. Statistically, no significant differences were found as regards IOP and postoperative anterior chamber irritation. From the economical point of view, methocel (HPMC) should be preferred to sodium hyaluronic acid in routine cataract surgery due to the lower costs.

Topics: Cataract Extraction; Humans; Hyaluronic Acid; Intraocular Pressure; Lactose; Lenses, Intraocular; Methylcellulose; Oxazines; Postoperative Complications

A multicenter prospective trial was conducted comparing preoperative and postoperative endothelial cell counts in patients who had extracapsular cataract extraction with posterior chamber lens implantation or phacoemulsification and posterior chamber lens implantation. One hundred sixty six eyes received 2% hydroxypropyl methylcellulose (Occucoat) and 56 eyes received sodium hyaluronate (Healon). The average cell loss in the Occucoat group was 12.1%; in the Healon group it was 10% (P = NS). There was no significant difference between the two groups in intraocular pressure at 24 hours. In this study Occucoat was as effective in protecting the corneal endothelium as Healon.

Topics: Aged; Cataract Extraction; Cell Count; Endothelium, Corneal; Humans; Hyaluronic Acid; Hypromellose Derivatives; Intraocular Pressure; Lenses, Intraocular; Methylcellulose; Postoperative Complications; Prospective Studies

In 65 patients, the safety of a 2% solution of hydroxypropylmethylcellulose (HPMC) was investigated by comparing HPMC with a balanced salt solution during posterior chamber lens implantation. The controlled open randomized trial consisted of two groups of patients: 1) in 37 patients the surface of the implant was coated with HPMC and the inner wound sealed prior to insertion; 2) in the control group with 28 patients the lens was dipped in the balanced salt solution. There were no statistically significant differences between the two groups as regards any of the characteristics investigated, such as visual acuity, intraocular pressure, corneal thickness, endothelial cell loss, and postoperative irritation within the anterior chamber. There was no rise in mean intraocular pressure in the HPMC group on the first postoperative day, and a rise of 1 mm Hg in the control group. The increase in corneal thickness on the first postoperative day in the HPMC group was 0.07 and in the control group 0.04 mm. At re-examination (50th postoperative day) the mean thickness in both groups was identical to the initial values. The mean endothelial cell loss at re-examination was 18% (+/- 16%). No serious side effects were observed. HPMC may be regarded as a well-tolerated viscoelastic substance.

Topics: Aged; Clinical Trials as Topic; Cornea; Endothelium, Corneal; Humans; Hypromellose Derivatives; Intraocular Pressure; Lenses, Intraocular; Methylcellulose; Postoperative Complications; Random Allocation; Visual Acuity

In a randomised trial the endothelial protective agent used during extracapsular cataract extraction and intraocular lens insertion was air in 19 eyes (group 1), methylcellulose in 25 eyes (group 2) and sodium hyaluronate in 22 (group 3). The cell population densities of each eye were estimated immediately before and three months after the operations to determine the degree of cell loss. Eyes showing mechanical (touch) damage on the second postoperative day were eliminated. The numbers of eyes in each group which showed a statistically significant cell loss were compared, and the mean cell losses in each group were tested for significant differences. It appears that air actually damages the endothelium while methylcellulose and Na-hyaluronate are not harmful, and afford a high, essentially equal degree of endothelial protection.

Topics: Adult; Aged; Aged, 80 and over; Air; Cell Count; Clinical Trials as Topic; Endothelium, Corneal; Humans; Hyaluronic Acid; Hypromellose Derivatives; Intraocular Pressure; Lenses, Intraocular; Methylcellulose; Middle Aged; Postoperative Complications; Random Allocation

Submucosal injection is used to prevent complications, such as perforation, during endoscopic mucosal resection (EMR). Since injection of normal saline produces mucosal elevation of short duration, repeated injection is needed for extensive resection. To overcome this limitation, various submucosal injection solutions have been developed but there are few data comparing their efficacy. This study was therefore conducted to compare the physical and chemical properties and the duration of mucosal elevation of various submucosal injection solutions.. A fresh transverse colon specimen acquired from a mongrel was used. Experiments were repeated four times. To compare the efficacy of mucosal elevation, 1 ml of each solution was injected into the submucosa: 0.9% NaCl, 20% mannitol, 0.1% sodium hyaluronate, 0.3% hydroxypropyl methylcellulose (HPMC), and 2% fibrinogen. Physical and chemical properties such as viscosity and osmolarity were compared.. The heights of initial mucosal elevations were 6.52+/-0.26 mm, 6.87+/-0.05 mm, 6.92+/-0.09 mm, 6.90+/-0.08 mm, and 6.90+/-0.08 mm for normal saline, mannitol, sodium hyaluronate, HPMC, and fibrinogen, respectively. Whereas injection of normal saline took about 20 min and mannitol about 30 min for the initial elevation to be reduced to more than half the initial height, it took more than 60 min for all the other agents. A correlation was found between the duration of mucosal elevation and viscosity but not with osmolarity.. The mucosal elevation lasted longer with sodium hyaluronate, HPMC, and fibrinogen than with mannitol or normal saline, and this seems to be due to the viscosity rather than the osmolarity of each solution.

Topics: Animals; Colon; Colonoscopy; Dogs; Fibrinogen; Hyaluronic Acid; Hypromellose Derivatives; In Vitro Techniques; Injections; Intestinal Mucosa; Mannitol; Methylcellulose; Osmolar Concentration; Postoperative Complications; Sodium Chloride; Solutions; Viscosity

To examine the change in intraocular pressure (IOP) within 1 week of phacoemulsification and foldable posterior chamber intraocular lens (PC IOL) implantation using Adatocel (hydroxypropyl methylcellulose 2% [HPMC]).. Department of Ophthalmology, University of Sciences, Faculty of Medicine, Pécs, Hungary.. In this prospective study, the IOP in 118 eyes of 118 patients (57 men, 61 women, mean age 68 years +/- 7.8 [SD]) with no history of glaucoma was assessed by Goldmann applanation tonometry 2 to 3, 6 to 8, and 22 to 24 hours and 1 week after uneventful phacoemulsification and PC IOL implantation. The effect of the removal of Adatocel ("partial removal" from the anterior chamber [AC] only versus "complete removal" from behind of the IOL as well), the lens type (Medicontur 601 HP versus Bausch & Lomb Hydroview), and the type of anesthesia (topical versus parabulbar) were compared. Statistical analysis was performed using the Student t test, and P< or =.05 was considered statistically significant.. The mean preoperative IOP was 13.83 +/- 2.5 mmHg. There were no significant differences at any time in postoperative IOP measurements between the 2 IOL types and the 2 modes of anesthesia. At 2 to 3 hours, 6 to 8 hours, and 22 to 24 hours, the IOP was significantly higher in the 30 eyes in which the Adatocel was partially removed (from the AC only) than in the 88 eyes in which it was completely removed (from behind the PC IOL as well) (P< or =.05, P< or =.01, and P< or =.001, respectively).. Severe postoperative IOP spikes in nonglaucomatous patients after uneventful phacoemulsification cataract surgery are rare. The type of implanted PC IOL and the mode of anesthesia had no significant effect on postoperative IOP. Total removal of the ophthalmic viscosurgical device, even when using HPMCs such as Adatocel, is necessary to prevent postoperative IOP spikes.

Topics: Adult; Aged; Aged, 80 and over; Anesthesia, Local; Female; Humans; Hypromellose Derivatives; Intraocular Pressure; Lens Implantation, Intraocular; Male; Methylcellulose; Middle Aged; Ocular Hypertension; Ophthalmic Solutions; Phacoemulsification; Postoperative Complications; Prospective Studies; Tonometry, Ocular

To quantify the oxidative tissue damage after phacoemulsification, correlate the damage to the energy applied, and investigate the influence of ophthalmic viscosurgical devices (OVDs).. Department of Ophthalmology, University of Mainz, Mainz, Germany.. The study comprised 130 eyes operated on by 1 surgeon using the same phacoemulsification machine. Some eyes received an OVD before phacoemulsification and some did not. Energy values were expressed as phaco time; that is, ultrasound (US) time (seconds) after conversion to 100% phaco power. Patients were grouped as follows: Group 1, phaco time less than 20 seconds and no OVD; Group 2, phaco time 20 to 40 seconds and no OVD; Group 3, phaco time more than 40 seconds and no OVD; Group 4, phaco time 20 to 40 seconds and hydroxypropyl methylcellulose 2% (HPMC); Group 5, phaco time 20 to 40 seconds and sodium hyaluronate 1%. Aqueous humor from pseudophakic eyes served as a control. At the end of surgery, anterior chamber fluid was analyzed for lipid peroxides using the thiobarbituric acid method.. Lipid peroxides were detected in all groups. The values were significantly higher in Group 2 than in Group 1 (P<.01) and in Group 3 than in Groups 1 and 2 (P<.01). The differences in lipid peroxide values between all phaco groups and the control group were statistically significant. Sodium hyaluronate 1% and HPMC 2% produced significantly lower lipid peroxide values than in the respective phaco groups that did not receive an OVD (both P<.01).. Oxidative tissue damage occurred during phacoemulsification. The damage, which correlated with the US energy applied, can be reduced by the use of OVDs.

Topics: Aged; Aqueous Humor; Free Radical Scavengers; Free Radicals; Humans; Hyaluronic Acid; Lactose; Lipid Peroxidation; Lipid Peroxides; Methylcellulose; Oxazines; Oxidative Stress; Phacoemulsification; Postoperative Complications; Thiobarbituric Acid Reactive Substances

Our objective was a prospective comparison of MR enteroclysis (MRE) with multidetector spiral-CT enteroclysis (MSCTE). Fifty patients with various suspected small bowel diseases were investigated by MSCTE and MRE. The MSCTE was performed using slices of 2.5 mm, immediately followed by MRE, obtaining T1- and T2-weighted sequences, including gadolinium-enhanced acquisition with fat saturation. Three radiologists independently evaluated MSCTE and MRE searching for 12 pathological signs. Interobserver agreement was calculated. Sensitivities and specificities resulted from comparison with pathological results ( n=29) and patient's clinical evolution ( n=21). Most pathological signs, such as bowel wall thickening (BWT), bowel wall enhancement (BWE) and lymphadenopathy (ADP), showed better interobserver agreement on MSCTE than on MRE (BWT: 0.65 vs 0.48; BWE: 0.51 vs 0.37; ADP: 0.52 vs 0.15). Sensitivity of MSCTE was higher than that of MRE in detecting BWT (88.9 vs 60%), BWE (78.6 vs 55.5%) and ADP (63.8 vs 14.3%). Wilcoxon signed-rank test revealed significantly better sensitivity of MSCTE than that of MRE for each observer ( p=0.028, p=0.046, p=0.028, respectively). Taking the given study design into account, MSCTE provides better sensitivity in detecting lesions of the small bowel than MRE, with higher interobserver agreement.

Topics: Artifacts; Contrast Media; Enema; Female; Gadolinium DTPA; Gastrointestinal Hemorrhage; Humans; Inflammatory Bowel Diseases; Injections, Intravenous; Intestinal Diseases; Intestine, Small; Magnetic Resonance Imaging; Male; Methylcellulose; Middle Aged; Observer Variation; Postoperative Complications; Prospective Studies; Sensitivity and Specificity; Tomography, Spiral Computed

26 cases of corneal opacity after cataract surgery occurred in a period of 2 weeks in one surgical unit. Cases occurred after a change in source of intraocular hypromellose solution and only among patients in whom the new product had been used.

Topics: Cataract Extraction; Cellulose; Corneal Opacity; Drug Combinations; Drug Contamination; Humans; Hypromellose Derivatives; Methylcellulose; Postoperative Complications

Topics: Abdominal Neoplasms; Adenocarcinoma, Mucinous; Adult; Barium Sulfate; Enema; Humans; Intestinal Obstruction; Intestine, Small; Magnetic Resonance Imaging; Male; Methylcellulose; Postoperative Complications; Pseudomyxoma Peritonei

To evaluate the usefulness of four viscoelastic agents during phacoemulsification: 2% hydroxypropylmethylcellulose (HPMC) (Methocel), 3% sodium hyaluronate with 4% chondroitin sulfate (Viscoat), 1% sodium hyaluronate (Healon), 1.4% sodium hyaluronate (Healon GV).. Eye Clinic, Kreiskrankenhaus Bad Hersfeld, Germany.. Two hundred patients, divided into four groups of 50 patients, received one of the viscoelastic substances during phacoemulsification and posterior chamber intraocular lens implantation. Patients were followed for 1 month. Visual acuity and intraocular pressure (IOP) were measured. The following were subjectively evaluated for each viscoelastic: corneal findings, anterior chamber reaction, visibility of intraocular structures and retention time during phacoemulsification, space maintaining ability, and removability and ease of injection.. Postoperative IOP and visual acuity were comparable among the four groups. Viscoat tended to trap nuclear fragments and air bubbles during the phacoemulsification procedure, which decreased visibility during surgery. Space maintenance and injection ease were significantly better with Healon and Healon GV.. The high molecular weight viscoelastics (Healon and Healon GV) performed better as viscosurgical tool during cataract surgery using phacoemulsification.

Topics: Chondroitin Sulfates; Follow-Up Studies; Humans; Hyaluronic Acid; Hypromellose Derivatives; Intraocular Pressure; Lenses, Intraocular; Methylcellulose; Phacoemulsification; Postoperative Complications; Visual Acuity

The one significant complication of viscoelastic materials is that they may cause postoperative intraocular pressure rise. We investigated the rate and ease of removal of various viscoelastics using the Miyake video technique. Five viscoelastics were investigated: sodium hyaluronate (Healon), Healon GV, chondroitin sulfatesodium hyaluronate (Viscoat), hydroxypropylmethylcellulose (Occucoat), and polyacrylamide (Orcolon). The viscoelastics were dyed with fluorescein and, after filling the capsular bag with a viscoelastic material, a posterior chamber intraocular lens (IOL) was implanted. The viscoelastic was then aspirated using an automated irrigation/aspiration device. Healon and Healon GV were completely removed within 20 to 25 seconds. Viscoat adhered to the lens capsule and to the posterior surface of the IOL and cooplete removal required approximately 3.5 minutes. Most Occucoat and Orcolon was aspirated within one minute; however, removal was completed only after three minutes. Removal of Healon and Healon GV was faster and more complete than removal of the other viscoelastics. Whether a small amount of viscoelastic left in the eye or trapped behind the IOL optic has any clinical significance has to be studied.

Topics: Acrylic Resins; Cataract Extraction; Glycosaminoglycans; Humans; Hyaluronic Acid; Hypromellose Derivatives; Intraocular Pressure; Lenses, Intraocular; Methylcellulose; Postoperative Complications; Suction

Topics: Cornea; Corneal Diseases; Humans; Hyperopia; Hypromellose Derivatives; Laser Therapy; Methylcellulose; Postoperative Complications

We studied prospectively the effects of 2% hydroxypropylmethylcellulose (HPMC), instilled in to the anterior chamber during extracapsular cataract extraction with posterior chamber intraocular lens implantation in 122 patients. Significant pressure rise was noted at 12 and 24 hours post-operatively when HPMC was not removed at the end of surgery. This was prevented by washing HPMC from the anterior chamber at the end of surgery, or by using either acetazolamide or a combination of oxyphenbutazone and vitamin C without washing HPMC. There was no difference in intraocular inflammation between controls and the HPMC groups. The group receiving combined oxyphenbutazone and vitamin C had the least, the differences between these two groups being sufficient.

Topics: Acetazolamide; Anterior Chamber; Ascorbic Acid; Cataract Extraction; Female; Humans; Hypromellose Derivatives; Inflammation; Intraocular Pressure; Lenses, Intraocular; Male; Methylcellulose; Ophthalmic Solutions; Oxyphenbutazone; Postoperative Complications; Prospective Studies; Time Factors

Activity of peritoneal plasminogen activator and its regulation by dextran and other macromolecules that clinically suppress postoperative adhesions was studied. Plasminogen activator activity was assayed by a two-stage globinolytic assay that monitors formation of plasmin, as well as by cleavage of a chromogenic peptide substrate (S-2444) in the presence of aprotinin (Trasylol). Plasminogen activator activity was located on the outer surface of human peritoneum. Incubation of peritoneal tissue with buffer in vitro (conditioning) prompted release of plasminogen activator into the conditioning medium. The released plasminogen activator formed a single band on sodium dodecyl sulfate-gel electrophoresis at an apparent molecular weight of 174,000 and was markedly suppressed by antiserum raised against human melanoma tissue-type plasminogen activator. Nonspecific proteolytic activity did not accumulate in the medium during conditioning. The presence of dextran 80 during conditioning of peritoneum reversibly suppressed tissue-bound plasminogen activator activity and reduced plasminogen activator activity in the spent medium. A similar inhibition of peritoneal plasminogen activator was induced by dextran 500, methyl cellulose, and polyvinylpyrrolidone. Dextran, when added to the medium after conditioning, had no direct inhibitory effect on plasminogen activator activity. Dextran did not induce peritoneal production of inhibitor(s) of trypsin, chymotrypsin, or urokinase. On the basis of these findings, two possible mechanisms for the effect of viscous polymers in the reduction of adhesion formation are proposed. These mechanisms consider the importance of peritoneal tissue-type plasminogen activator for removal of fibrin clots and suggest that polymer coating either prevents the shedding of plasminogen activator into the abdominal cavity or reduces the access of fibrin clots to the serosal surfaces.

Topics: Abdomen; Dextrans; Humans; In Vitro Techniques; Macromolecular Substances; Methylcellulose; Peritoneum; Plasminogen Activators; Postoperative Complications; Povidone; Tissue Adhesions; Viscosity

Topics: Animals; Aprotinin; Carboxymethylcellulose Sodium; Female; Genitalia, Female; Hydrocortisone; Methylcellulose; Microsurgery; Postoperative Complications; Rats; Tissue Adhesions

Pericardial adhesions subject patients requiring cardiac reoperation to potential injuries of the heart, great vessels, and extracardiac grafts during resternotomy. We evaluated polyvinylpyrrolidone (PVP) and a methlycellulose derivative (MCD) as intraoperative irrigating solutions in the prevention of postoperative pericardial adhesions. Fifteen dogs weighing 15 to 20 kg were divided into three equal cohorts and subjected to left thoracotomy with pericardiotomy. Prior to surgical manipulation, the pericardial cavity was irrigated with either PVP, MCD, or Ringer's lactate (RL). Serosal injury stimulating intraoperative trauma was induced by gauze sponge abrasion of the epicardium and inner surface of the pericardium and by allowing desiccation of serosal surfaces for 30 min. The pericardial cavity was evaluated for adhesion formation 6 weeks postoperatively by reoperation. Two independent observers, unaware of the study solution, evaluated the extent and severity of pericardial adhesions on a 0-4 scale. All dogs in the RL control group had surgically significant adhesions and a mean adhesion score of 3.2 +/- 1.1. In contrast, no PVP- or MCD-treated dog had surgically significant adhesions. The mean adhesion scores were 0.2 +/- 0.4 for PVP and 0.5 +/- 0.7 for MCD. Our results indicate that PVP (P less than 0.004) and MCD (P less than 0.024) significantly reduce pericardial adhesion formation when compared to RL. Clinical application of PVP or MCD for the prevention of pericardial adhesions should reduce morbidity and mortality of cardiac reoperation.

Topics: Animals; Heart Diseases; Methylcellulose; Pericardium; Polymers; Postoperative Complications; Povidone; Solutions; Tissue Adhesions

A study was designed to test chondroitin sulphate and other high-molecular-weight solutions, using the rabbit uterus as the surgical model, in the prevention of postoperative adhesions. Eighty-five mature white female New Zealand rabbits underwent surgical injury of each uterine horn, with surgical repair of the left horn only in all animals using 9-0 nylon. The rabbits were randomly divided into five groups: groups A, B and C received 25 mL of chondroitin sulphate, sodium carboxymethylcellulose or 32% dextran 70, respectively. The remaining two groups received either 50 mL of normal saline (D) or no solution (E). Postoperatively the animals were killed, and the adhesions were carefully scored. The results clearly demonstrated the superiority of chondroitin sulphate as an intraperitoneal treatment for the prevention of postoperative adhesions (P less than .001 vs. carboxymethyl cellulose, dextran, saline and control).

Topics: Animals; Carboxymethylcellulose Sodium; Chondroitin; Chondroitin Sulfates; Dextrans; Female; Injections, Intraperitoneal; Methylcellulose; Peritoneum; Postoperative Complications; Rabbits; Tissue Adhesions; Uterine Diseases

With the use of a rabbit surgical model, the ability of 1%, 2%, and 3% solutions of sodium carboxymethylcellulose to reduce postoperative uterine adhesions was determined. At all concentrations sodium carboxymethylcellulose was more effective than either 32% dextran 70 or heparinized lactated Ringer's solution. Neither the dextran nor Ringer's solution had a significant (p less than or equal to 0.05) effect. The beneficial effects of sodium carboxymethylcellulose were closely dose-dependent (correlation coefficient 0.97). Sodium carboxymethylcellulose is highly effective in reducing postoperative adhesions in laboratory animals, and additional studies are warranted to further define its efficacy and safety.

Topics: Animals; Autopsy; Carboxymethylcellulose Sodium; Dextrans; Dose-Response Relationship, Drug; Female; Isotonic Solutions; Methylcellulose; Microsurgery; Peritoneal Diseases; Postoperative Complications; Rabbits; Ringer's Lactate; Solutions; Tissue Adhesions; Uterus

Topics: Adult; Aged; Cataract Extraction; Child, Preschool; Female; Humans; Infant; Male; Methylcellulose; Middle Aged; Postoperative Complications; Prognosis

Topics: Animals; Humans; Injections, Subcutaneous; Lenses, Intraocular; Methylcellulose; Postoperative Complications; Rabbits; Rats; Vitreous Body

Solutions of sodium carboxymethylcellulose (SCMC) were studied in rats to determine their longevity within the peritoneal cavity and their potential for prevention of postoperative intraperitoneal adhesions. In 18 rats, test solutions of SCMC and 10% dextran 40 were instilled at laparotomy. At 48 hours copious amounts of SCMC remained, whereas no 10% dextran 40 could be detected. In addition, standardized surgical injury was produced on the ceca of 100 rats at laparotomy. All control animals had significant adhesions at 2 weeks. Eighty-two percent of the 10% dextran 40 group had significant adhesions, while only 16% of the 0.9 wt% SCMC and 17% of the 1.0 wt% SCMC groups had significant adhesions. Solutions of SCMC were significantly more effective than 10% dextran 40 in the prevention of adhesions (P less than 0.001). Properties of SCMC and a possible mechanism for its striking effectiveness in adhesion prevention in this study are discussed.

Topics: Animals; Carboxymethylcellulose Sodium; Dextrans; Female; Methylcellulose; Peritoneal Cavity; Postoperative Complications; Rats; Sodium; Solutions; Time Factors; Tissue Adhesions

In a rat model, sodium carboxymethylcellulose (SCMC) was compared with normal saline and 32% dextran 70 in the prevention of surgically induced intraperitoneal adhesions. The 32% dextran 70 was similar to normal saline in the initial prevention of adhesions, and both appeared less effective than SCMC. After lysis of the initial adhesions, SCMC was significantly more effective than 32% dextran 70 in the prevention of the reformation of adhesions. Possible mechanisms of action, complications of SCMC, and the need for further research in finding an ideal solution for use in adhesion prevention are discussed.

Topics: Animals; Carboxymethylcellulose Sodium; Dextrans; Female; Methylcellulose; Peritoneal Cavity; Postoperative Complications; Rats; Sodium Chloride; Solutions; Time Factors; Tissue Adhesions

We evaluated the safety and efficacy of 2% methycellulose as an adjunct for cataract extraction with implantation in cat and monkey models. When used intraoperatively, methylcellulose reduced the iridovitreal bulge during surgery. No significant increase in clinical inflammation occurred nor was there statistically significant intraocular pressure elevation at 24 hours, 7 days, or 90 days. In the cat model, the central corneal thickness increased at day seven in both control and methylcellulose eyes; this thickness persisted to 90 days. The endothelial cell loss decreased significantly at day 90 in methylcellulose eyes. In the monkey model, no statistically significant increase in corneal thickness occurred in control or methylcellulose eyes at day seven. The endothelial cell loss was greater than in the cat model in both control and methylcellulose eyes; there was no statistically significant difference between the two. Two percent methylcellulose was safe in both the cat and monkey models. It facilitated surgery in both models and reduced the endothelial cell loss in the cat eye.

Topics: Animals; Cataract Extraction; Cats; Cell Count; Cornea; Endophthalmitis; Endothelium; Haplorhini; Intraocular Pressure; Lenses, Intraocular; Methylcellulose; Postoperative Complications

Methylcellulose 1% was used in the anterior chamber to facilitate posterior chamber lens implantation at the time of extracapsular cataract extraction. In parallel series with similar preoperative endothelial cell counts, 70 eyes implanted under methylcellulose had a mean central endothelial cell loss of 8 +/- 5.3% at 8 to 12 weeks postoperative, whereas 63 eyes implanted under an air bubble lost a mean 25.3 +/- 14.6% (P less than 0.001). No differences in postoperative visual acuity, intraocular pressure, or inflammation were noted. A YAG laser preoperative anterior capsulotomy was used in all cases, and may have contributed to overall preservation of endothelial cells.

Topics: Anterior Chamber; Cataract Extraction; Cell Count; Endothelium; Humans; Lenses, Intraocular; Methylcellulose; Postoperative Complications

Topics: Acetylcysteine; Adult; Cautery; Contact Lenses; Eyelids; Female; Humans; Keratoconjunctivitis; Lacrimal Apparatus; Metabolic Diseases; Methods; Methylcellulose; Ophthalmic Solutions; Parotid Gland; Postoperative Complications; Sjogren's Syndrome; Surgery, Plastic; Sympathectomy

Topics: Adult; Aged; Cataract Extraction; Cornea; Debridement; Female; Humans; Keratitis; Male; Methylcellulose; Middle Aged; Postoperative Complications; Prednisolone; Silver Nitrate; Sodium Chloride; Sulfacetamide; Time Factors

Topics: Acrylic Resins; Adolescent; Adult; Aged; Child; Child, Preschool; Eye Diseases; Eye Injuries; Eye Neoplasms; Eye, Artificial; Female; Follow-Up Studies; Glaucoma; Humans; Male; Melanoma; Methods; Methylcellulose; Middle Aged; Nystagmus, Pathologic; Ophthalmic Solutions; Ophthalmologic Surgical Procedures; Pemphigus; Postoperative Complications; Silicones; Suture Techniques; Trachoma