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B. M. Cavalcanti, K. C. F. Leitão, W. O. C. Lira, R. F. Cavalcanti, C. M. M. B. Castro; Analysis of Ascorbic Acid Antioxidant Protection Against Corneal Endothelial Damage by Free Radicals in Phacoemulsification Surgeries. Invest. Ophthalmol. Vis. Sci. 2009;50(13):2897.
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After phacoemulsification (PHACO) a reduction of the corneal endothelium density can occur. Specially, in dense cataracts the endothelial loss can reach 48.5% up to six months after surgery. The free radicals may play an important role. In animals, it was made clear that the use of ascorbic acid (AA), in concentrations 10 times higher than the physiologic pattern, in the irrigation solutions (IS), was safe and reduced the endothelial loss during the PHACO. The corneal thickness (PACHI) and Specular Endothelium Microscopy (EM) can be used as indirect methods of measurement of the surgical trauma. Therefore, the idea was to study the safety and the possible antioxidant protection of the AA against corneal endothelium damage during PHACO. Evaluation of the endothelial loss before and after surgery with and without the use of AA, PHACO time and the corneal thickness during the postoperative period was determined.
A double-blind and randomized study, was conducted at Altino Ventura Foundation, with 59 patients who had phacoemulsification. Only the patients with dense cataracts and without previous ocular disease were included. A complete ophthalmologic clinical and complementary exams such as ultra-sonography, PACHI, EM and biometry, was done as a pre-op routine. On the 7th day post-op pachimetry was taken and a month later both pachimetry and specular microscopy. The patients were divided in two randomized groups, consisting in group A (30 patients) and group B (29 patients). The PHACO technique was "stop and chop".
Both groups had similar number of patients, pre-op endothelial cell density, and PACHI, and PHACO ultrasound time at surgery. The group B had a endothelial loss 37,8% smaller than the group A. Both groups had similar PACHI measurements (pre, 7th and 30th post-op).
The endothelial cell loss was reduced after surgery probably due to the use of AA and it’s anti oxidation protection. The use of AA in the IS as an additional protection factor is suggested. The evaluation of who will be most beneficiated when relating to variables such as: pre-op Endothelium Cell Density, type of cataract and presence of oculars diseases should be established.
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