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Michael Mathison, Albert Li, Yicheng Bao, Andrew J W Huang, Rithwick Rajagopal; Impact of intraoperative ocular lubricants on corneal debridement rate during vitreoretinal surgery. Invest. Ophthalmol. Vis. Sci. 2019;60(9):5776. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Corneal transparency is crucial for visualization during vitreoretinal surgeries, yet it can be compromised by intraoperative corneal edema or epithelial abrasion, necessitating corneal debridement. A retrospective chart review was conducted to compare corneal debridement rates when using Viscoat (sodium chondroitin sulfate 4%-sodium hyaluronate 3%) or Goniosol (hydroxypropyl methylcellulose 2.5%) as intraoperative topical ocular lubricants.
Included patients underwent scleral buckling or pars plana vitrectomy by a single surgeon between 3/2013 and 3/2018. Between 3/13 and 3/15, patients were treated with Goniosol, whereas between 3/16 and 3/18 they were treated with Viscoat, after a systematic switch in the choice of corneal lubricant. Operative reports and medical records were reviewed to record baseline demographics, ocular history, surgical time, surgery type, and whether corneal debridement was performed in each case. Corneal debridement rates between groups were compared using the χ2 test.
Patients in the Viscoat group were younger than those in the Goniosol group (50.7 vs. 55.0 yrs.; p<.05) and more likely to be phakic (83.4% vs. 70.5%; p<.05), but with similar rates of diabetes (28.8% vs. 26.7%; p=.58). Indications for surgery were comparable, with rhegmatogenous retinal detachment being the most common in each group. In univariate analyses, patients receiving Goniosol (n=210) as compared to Viscoat (n=319) had higher rates of intraoperative corneal debridement (21.4% vs. 0%; p<.05). The mean surgical time was longer in the Goniosol group (98 vs. 78 mins; p<.05), despite a higher rate of complex procedures in the Viscoat group (34.8% vs 26.7%; p<.05).
Compared to Goniosol, corneal debridement rates and surgical times were lower using Viscoat as an intraoperative corneal lubricant in this study. Many factors may have contributed to our findings. Additives such as benzalkonium in Goniosol may damage the corneal epithelium or endothelium, compromising clarity. The dispersive viscoelastic properties of Viscoat may promote more effective corneal protection and its hyperosmolarity could deter corneal edema intraoperatively. Differences in baseline characteristics between groups may be a confounding factor. Nonetheless, our findings warrant further studies to validate the advantage of Viscoat over Goniosol as a corneal lubricant during vitreoretinal surgery.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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