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Chelsey Krambeer, Kinley Beck, Jeong-Hyeon Sohn, Ahmad Kheirkhah, Michael Singer; Occurrence of surgical epithelial debridement with use of hydroxypropyl methylcellulose vs. sodium hyaluronate-chondroitin sulfate for corneal coating during vitrectomy. Invest. Ophthalmol. Vis. Sci. 2019;60(9):5757. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Hydroxypropyl methylcellulose (HPMC, Goniosol) and sodium hyaluronate-chondroitin sulfate (HACS, DisCoVisc) can be used to protect the cornea and provide a clear view during vitrectomies. When the view for surgery decreases secondary to corneal clouding, the corneal epithelium is debrided which leaves the patient with a corneal abrasion. This study compared the occurrence of surgical epithelial debridments with the use of HPMC and HACS, and assessed the potential financial burden associated with management of abrasions in these patients.
This retrospective study reviewed 212 vitrectomies performed by the same surgeon over an 18-month period. Surgeries were divided into 2 groups based on use of HPMC or HACS. Age, gender, diabetic status, duration of surgery, presence of a post-operative corneal abrasion, and need for additional appointments to manage the abrasion were recorded. Logistic regression was used for statistical analysis.
HPMC was used in 79 surgeries and viscoelastic was used in 133. Patient demographics and surgical durations are listed in Table 1. Surgeries that used HPMC required debridments significantly more often (29.1%) than those that used HACS (0.8%), independent of surgery duration (p<.001). Significantly more additional appointments were necessary to manage corneal abrasions in the HPMC group (11.4%) than in the HACS group (1.5%)(p<.001). Patients in the HPMC group required 1 additional appointment each, while the patient in HACS group required two appointments.
The use of HACS for corneal coating significantly reduced the occurrence of debridments during vitrectomies when compared to HPMC. The cost of HPMC is $8.50, while the cost of HACS is $88. The cost to Medicare for an additional post-operative appointment is $85 in San Antonio, Texas. In addition, the patients experience unnecessary discomfort and are inconvenienced by additional appointments for corneal abrasions. While HACS is more expensive than HPMC, the overall costs associated with additional appointments and management of the abrasion exceed the extra cost of HACS.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
Table 1: Comparison of patient demographics and surgical data with use of hydroxypropyl methylcellulose (HPMC) vs. sodium hyaluronate-chondroitin sulfate (HACS)
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