<p>Impact of Intraoperative Ocular Lubricants on Corneal Debridement Rate During Vitreoretinal Surgery</p>

Abstract

Purpose: To compare surgical parameters among patients receiving Viscoat (sodium chondroitin sulfate 4%-sodium hyaluronate 3%) or Goniosol (hydroxypropyl methylcellulose 2.5%) as topical lubricants for retinal surgery. Methods: This was a retrospective analysis of patients undergoing retinal surgery between March 2013 and March 2018 using Goniosol or Viscoat as adjuvants. Primary outcome measures were rate of corneal debridement and operative time between groups, compared using χ 2 and t-tests, respectively. Results: Compared to Viscoat (n=319), the Goniosol group (n=210) had more frequent intraoperative corneal debridement (21.4% vs 0, p<0.05) and longer surgical times (98 vs 78 minutes, p<0.05). Patients in the Viscoat group had higher rates of complex procedures (34.8% vs 26.7%, p<0.05), but were younger (50.7 vs 55.0 years, p<0.05) and more likely to be phakic (83.4% vs 70.5%, p<0.05). Conclusion: These findings suggest potential advantages of using Viscoat over Goniosol for corneal lubrication to aid visualization during vitreoretinal surgery.

Complications in Retinal Surgery: A Review of Corneal Changes Following Vitreoretinal Procedures

“…Notably, corneal clarity during vitrectomy is of paramount importance to maintain visibility during critical intraoperative maneuvers, and it is often decreased because of corneal epithelial edema 31. The use of 2.5% hydroxypropyl methylcellulose, an intraoperative ocular lubricant used to aid visualization of vitreoretinal surgery, has been shown to reduce corneal clarity as it contains the preservative benzalkonium chloride, which has the potential for deep corneal penetration that can induce prolonged corneal inflammation, neurotoxicity, and decreased aqueous tear production 32–34. In contrast, 0.3% hydroxypropyl methylcellulose has been found to be less damaging to the corneal epithelium as it contains sodium perborate as a preservative, which produces hydrogen peroxide and its inert salt, sodium borate.…”

“…31 The use of 2.5% hydroxypropyl methylcellulose, an intraoperative ocular lubricant used to aid visualization of vitreoretinal surgery, has been shown to reduce corneal clarity as it contains the preservative benzalkonium chloride, which has the potential for deep corneal penetration that can induce prolonged corneal inflammation, neurotoxicity, and decreased aqueous tear production. [32][33][34] In contrast, 0.3% hydroxypropyl methylcellulose has been found to be less damaging to the corneal epithelium as it contains sodium perborate as a preservative, which produces hydrogen peroxide and its inert salt, sodium borate. Hydrogen peroxide is less toxic than benzalkonium chloride at the concentrations used and ultimately releases additional oxygen to what may be a hypoxic epithelium.…”

“…34 Similarly, sodium chondroitin sulfate 3%-sodium hyalunorate 4% may improve corneal clarity during vitreoretinal procedures as it does not contain preservatives, reduces fluid accumulation as it is hyperosmolar relative to the cornea, and has dispersive properties which may confer protection to the epithelium. 33 In the event of inadvertent corneal edema, intentional epithelial debridement may be performed to improve intraoperative visualization. 6 Likewise, in the case of severe anterior segment opacities impeding a clear view to perform a PPV, an endoscopic vitrectomy can be used to circumvent the poor view, allowing for a corneal transplant as a staged procedure instead of a combined one.…”

“…Hydrogen peroxide is less toxic than benzalkonium chloride at the concentrations used and ultimately releases additional oxygen to what may be a hypoxic epithelium 34. Similarly, sodium chondroitin sulfate 3%-sodium hyalunorate 4% may improve corneal clarity during vitreoretinal procedures as it does not contain preservatives, reduces fluid accumulation as it is hyperosmolar relative to the cornea, and has dispersive properties which may confer protection to the epithelium 33…”