Faster surgical times and less risk of postoperative IOP spikes are two advantages of forgoing viscoelastic substances, surgeon says.
Phacoemulsification without the use of viscoelastic is a safe and
effective procedure, according to a prospective study carried out at a research
center in Switzerland.
“Continuous [anterior chamber] irrigation maintains a stable
chamber and protects the endothelium from surgically induced damage,”
Bojan Pajic, MD, said. “We performed continuous circular capsulorrhexis
and then phacoemulsification with the stop-and-chop technique. Finally, we
implanted the IOL.”
During the procedure, balanced salt solution was used through the
irrigation and aspiration unit, without the use of viscoelastic, Dr. Pajic
Less surgical time
One of the advantages of not using viscoelastic is the faster surgical
“Cataract surgery can be carried out in 3 minutes,” Dr. Pajic
In addition, by eliminating the risk of leaving viscoelastic remnants in
the eye, the chance of postoperative IOP spikes is minimized.
A total of 126 patients were enrolled in the study and divided in two
groups, in which Healon (sodium hyaluronate, Abbott Medical Optics) and
balanced salt solution were used.
Postoperative data showed no significant difference between the groups
regarding endothelial cell loss.
The mean endothelial cell loss at 1 month was 106 cells/mm² (4.5%)
in the balanced salt solution group and 122 cells/mm² (5.3%) in the sodium
Age and cell loss
No significant difference was found regarding cell shape and size. IOP
was comparable in the two groups. However, a significant correlation was
observed between cell loss and age of the patients in both groups.
This approach has a learning curve, but in expert hands, it is safe and
holds several advantages, Dr. Pajic said. — by Michela Cimberle
- Bojan Pajic, MD, can be reached at the Swiss Eye Research Foundation,
AZP Augenzentrum Pajic, Reinach, Switzerland; e-mail:
This study shows that phacoemulsification without the use of
viscoelastic is a dream that can indeed come true. In our daily practice, since
irrigation is potentially traumatic to the endothelium and viscoelastic is the
most effective protection, we currently have to prevent endothelial damage. We
must consider if the advantages of not using it really outweigh the
disadvantages. However, phaco without visco is an alternative that deserves
further consideration, in view of the fast developments of microincision
techniques, where the quantity of fluids we introduce in the eye is far less
than in standard phaco. I still prefer to be on the safe side and use visco,
but I see a lot of potential in this alternative procedure for future
– Alessandro Galan, MD
Sant’Antonio Eye Clinic, Padua, Italy