Prospective Nonrandomized Comparison of Different OVD´s in Non-eventful Phacoemulsification ASCRS, 2008 Fernando Aguilera ...
Introduction <ul><li>OVD´s protection and space formation have allowed phaco to be the prefered method for cataract extrac...
Ovd’s clasification Low Viscosity Dispersive Viscoadaptives and Superviscous Cohesives Viscous Cohesive Dis Co Visc ™ Visc...
usa market ovd´s
objective <ul><li>Compare clinical results and machine parameters between different OVD´s in phaco </li></ul><ul><li>Visco...
Material and methods prospective, comparative, nonrandomized <ul><li>Data 200 patients non complicated M.C.T. phaco </li><...
Transoperative OVD behavior evaluation: 1- Ease of injection 2- Visibility  3- Pupil manipulation 4- AC maintainance (ccc,...
Results :  subjective Mean Surgical Difficulty by OVD 0 1 2 3 Cataract Extraction IOL Insertion Overall Difficulty Level D...
Mean Ease of Injection and Visualization Post Injection 1=Poor  2=Fair  3=Good  4=Excellent  0 1 2 3 4 DisCoVisc DuoVisc B...
Anterior Chamber Maintenance During Surgical Phases 0 1 2 3 4 5 Anterior Capsulotomy Phacoemulsification IOL Insertion Mai...
Mean Ocular Inflammation 1 Day Postoperatively 0 1 2 3 Edema Cell Flare Inflammation Level DisCoVisc DuoVisc BioVisc Healo...
Results  objective
Mean Endothelial Cell Count Pre- and Post-Operatively 0 500 1000 1500 2000 PreOp 1 Month Post 2 Months Post cells/mm2 DisC...
Mean Pachymetry Pre- and Post-operatively 500 520 540 560 PreOp 1 Month Post 2 Months Post um DisCoVisc DuoVisc BioVisc He...
p = 0.0290  Note:   A statistically significant difference (p = 0.0290 ) was found for % ECC loss by CDE level.
2 Month Postop: % ECC Loss by CDE Level -10 0 10 20 30 40 50 60 <5.0 >5 to <10 >10 to <15 >15 to <20 >20 CDE Range ECC Los...
2 Month Postoperative: ECC Loss by BSS Volume -10 0 10 20 30 40 50 60 70 ? 100 101-200 201-300 BSS Volume (mL) cells/mm2 D...
ECC Loss by CDE and BSS Levels 0 10 20 30 40 50 <5.0 >5 to <10 >10 to <15 >15 to <20 >20 CDE  cells/mm2 ? 100 101-200 201-...
2 Months Postoperatively: Percent ECC Loss by Preoperative ECC -10 0 10 20 30 40 ECC <1500 Preop ECC >1500 Preop Percent L...
Note:   *  indicates OVD with statistically significantly less ECC loss  per Tukey’s studentized range test . % ECC Loss P...
Discusion <ul><li>Higher energy of US was related to more ecc loss  (CDE > 10) </li></ul><ul><li>Higher levels of BSS were...
Conclusion <ul><li>Viscodispersive (Discovisc) and Dispersive-Cohesive combination (Duovisc) OVD´s produced less ECC loss ...
<ul><li>Thank  you </li></ul><ul><li>Fernando Aguilera MD </li></ul>
Mean Number of OVD Vials Utilized per Case  0 0.5 1 1.5 2 2.5 DisCoVisc DuoVisc BioVisc Healon5 AmviscPlus Vial Number
Mean Infiniti CDE Reading by OVD 0 2 4 6 8 10 DisCoVisc DuoVisc BioVisc Healon5 AmviscPlus CDE
Mean Grade of Cataract by OVD 1=Soft  2=Medium  3=Hard  4= Brittle 0 1 2 3 4 DisCoVisc DuoVisc BioVisc Healon5 AmviscPlus ...
Mean Estimated Percent of OVD Retention 0 3 6 9 12 15 DisCoVisc DuoVisc BioVisc Healon5 AmviscPlus Percent
Mean Capsural Bag Maintenance During Surgery 1=Poor  2=Fair  3=Good  4=Excellent 0 1 2 3 4 DisCoVisc DuoVisc BioVisc Healo...
Mean Difficulty of OVD Aspiration 1=Very Easy  2=Easy  3=Neither Easy or Difficult  4=Difficult  5=Very Difficult  0 1 2 3...
Mean Effectiveness of Pupil Expansion 1=Not Effective  2=Moderately Effective  3=Very Effective 0 1 2 3 DisCoVisc DuoVisc ...
Mean Intraocular Pressure 1 Day Postoperatively 0 5 10 15 20 DisCoVisc DuoVisc BioVisc Healon5 AmviscPlus mmHg
Percent ECC Loss by Cataract Grade: Preop to 2 Month Postop  -10 0 10 20 30 40 1 2 3 4 Cataract Grade Percent DisCoVisc Du...
Note:   No statistical difference exists (p = 0.5489)   in % ECC loss by cataract grade. (p = 0.5489)
2 Months Postop: % ECC Loss by CDE Level (All OVDs) 0 10 20 30 40 50 <5.0 >5 to <10 >10 to <15 >15 to <20 >20 CDE Range % ...
 
MCTo ECC:  8%  < ToSt  /  16%  < Trphaco MCTo Pach: >< ToSt /  16%  < Trphaco 9.6% 8.9% 8.1% 5.2% 4.0% 4.1% 0.0% 2.0% 4.0%...
TORSIONAL VS LINEAR <ul><li>Literature : Less Ultrasound energy and BSS used during phaco diminishes the risk for endothel...
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OVD RESULTS IN PHACO

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OPHTHALMOLOGY
CORNEAL RESULTS OF 5 DIFFERENT OVD´S IN PHACO

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  • OVD RESULTS IN PHACO

    1. 1. Prospective Nonrandomized Comparison of Different OVD´s in Non-eventful Phacoemulsification ASCRS, 2008 Fernando Aguilera MD NO FINANCIAL INTEREST
    2. 2. Introduction <ul><li>OVD´s protection and space formation have allowed phaco to be the prefered method for cataract extraction in normal and complex cases </li></ul><ul><li>OVD´s clasification is based in numerical values of: zero shear viscosity and cohesion </li></ul><ul><li>(Arshinoff;JCRS2005;31:2167-2171) </li></ul>
    3. 3. Ovd’s clasification Low Viscosity Dispersive Viscoadaptives and Superviscous Cohesives Viscous Cohesive Dis Co Visc ™ Viscoat ® Cellugel ® Ocucoat ® Healon ® -GV Healon ® -5 Healon ® Provisc ® Amvisc ® Visco Dispersive
    4. 4. usa market ovd´s
    5. 5. objective <ul><li>Compare clinical results and machine parameters between different OVD´s in phaco </li></ul><ul><li>Viscodispersive:………… Discovisc </li></ul><ul><li>Viscoadaptive:…...……… Healon 5 </li></ul><ul><li>Cohesive:…………………Biovisc , Amvisc Plus </li></ul><ul><li>Combination (Di-Co)…… Duovisc </li></ul>
    6. 6. Material and methods prospective, comparative, nonrandomized <ul><li>Data 200 patients non complicated M.C.T. phaco </li></ul><ul><li>Same surgeon (FAZ) </li></ul><ul><li>Infiniti OZiL, Intrepid FMS, 30° miniflared Kelman tip, </li></ul><ul><li>Blended torsional-conventional burst phaco </li></ul><ul><li>Pre-postop: complete ophthalmic exam </li></ul><ul><li>ECC,PM,IOP </li></ul><ul><li>EVALUATION (SUBJECTIVE)Transop: </li></ul><ul><li>questionarie for each case of ovd transoperative behavior </li></ul><ul><li>EVALUATION (OBJECTIVE): </li></ul><ul><li>Measurement of CDE (cumulative delivered energy) </li></ul><ul><li>Measurement of BSS (electric weight with double pole extension) </li></ul><ul><li>1.-Phaco 2.-Cortex I/A 3.- Asp post-IOL implanation </li></ul><ul><li>Postop. Evaluations : 1,7,30.60 days, including: ECC,PM,IOP, </li></ul>
    7. 7. Transoperative OVD behavior evaluation: 1- Ease of injection 2- Visibility 3- Pupil manipulation 4- AC maintainance (ccc, Phaco) 5- IOL implantation 6- I/A post IOL
    8. 8. Results : subjective Mean Surgical Difficulty by OVD 0 1 2 3 Cataract Extraction IOL Insertion Overall Difficulty Level DisCoVisc DuoVisc BioVisc Healon5 AmviscPlus
    9. 9. Mean Ease of Injection and Visualization Post Injection 1=Poor 2=Fair 3=Good 4=Excellent 0 1 2 3 4 DisCoVisc DuoVisc BioVisc Healon5 AmviscPlus Level of Ease Injection Visualization
    10. 10. Anterior Chamber Maintenance During Surgical Phases 0 1 2 3 4 5 Anterior Capsulotomy Phacoemulsification IOL Insertion Maintenance Scale DisCoVisc DuoVisc BioVisc Healon5 AmviscPlus
    11. 11. Mean Ocular Inflammation 1 Day Postoperatively 0 1 2 3 Edema Cell Flare Inflammation Level DisCoVisc DuoVisc BioVisc Healon5 AmviscPlus
    12. 12. Results objective
    13. 13. Mean Endothelial Cell Count Pre- and Post-Operatively 0 500 1000 1500 2000 PreOp 1 Month Post 2 Months Post cells/mm2 DisCoVisc DuoVisc BioVisc Healon5 AmviscPlus
    14. 14. Mean Pachymetry Pre- and Post-operatively 500 520 540 560 PreOp 1 Month Post 2 Months Post um DisCoVisc DuoVisc BioVisc Healon5 AmviscPlus
    15. 15. p = 0.0290 Note: A statistically significant difference (p = 0.0290 ) was found for % ECC loss by CDE level.
    16. 16. 2 Month Postop: % ECC Loss by CDE Level -10 0 10 20 30 40 50 60 <5.0 >5 to <10 >10 to <15 >15 to <20 >20 CDE Range ECC Loss DisCoVisc DuoVisc BioVisc Healon5 AmviscPlus
    17. 17. 2 Month Postoperative: ECC Loss by BSS Volume -10 0 10 20 30 40 50 60 70 ? 100 101-200 201-300 BSS Volume (mL) cells/mm2 DisCoVisc DuoVisc BioVisc Healon5 AmviscPlus
    18. 18. ECC Loss by CDE and BSS Levels 0 10 20 30 40 50 <5.0 >5 to <10 >10 to <15 >15 to <20 >20 CDE cells/mm2 ? 100 101-200 201-300
    19. 19. 2 Months Postoperatively: Percent ECC Loss by Preoperative ECC -10 0 10 20 30 40 ECC <1500 Preop ECC >1500 Preop Percent Loss All OVDs DisCoVisc DuoVisc BioVisc Healon5 AmviscPlus
    20. 20. Note: * indicates OVD with statistically significantly less ECC loss per Tukey’s studentized range test . % ECC Loss Preop to 2 Months Postop: Statistically Significant Pairs p < 0.05 p < 0.05 p < 0.05 DisCoVisc* p < 0.05 p < 0.05 p < 0.05 DuoVisc* p < 0.05 AmviscPlus BioVisc AmviscPlus* Healon5
    21. 21. Discusion <ul><li>Higher energy of US was related to more ecc loss (CDE > 10) </li></ul><ul><li>Higher levels of BSS were related to more ecc loss ( > 100 ml) </li></ul><ul><li>Overall the Viscodispersive OVD (Discovisc) cataract cases had better clinical and subjective outcomes </li></ul>
    22. 22. Conclusion <ul><li>Viscodispersive (Discovisc) and Dispersive-Cohesive combination (Duovisc) OVD´s produced less ECC loss and Corneal edema in Microcoaxial Torsional Phacoemulsification than Viscoadaptive and viscous cohesive OVD´s (statistically significant) </li></ul><ul><li>Cohesive OVD´s were related to more ECC loss in harder cataracts and should not be used in grades 4 and above (worst case 49% loss) </li></ul><ul><li>Viscodispersive OVD´s (Discovisc) are indicated in any grade of cataract hardness </li></ul>
    23. 23. <ul><li>Thank you </li></ul><ul><li>Fernando Aguilera MD </li></ul>
    24. 24. Mean Number of OVD Vials Utilized per Case 0 0.5 1 1.5 2 2.5 DisCoVisc DuoVisc BioVisc Healon5 AmviscPlus Vial Number
    25. 25. Mean Infiniti CDE Reading by OVD 0 2 4 6 8 10 DisCoVisc DuoVisc BioVisc Healon5 AmviscPlus CDE
    26. 26. Mean Grade of Cataract by OVD 1=Soft 2=Medium 3=Hard 4= Brittle 0 1 2 3 4 DisCoVisc DuoVisc BioVisc Healon5 AmviscPlus Grade
    27. 27. Mean Estimated Percent of OVD Retention 0 3 6 9 12 15 DisCoVisc DuoVisc BioVisc Healon5 AmviscPlus Percent
    28. 28. Mean Capsural Bag Maintenance During Surgery 1=Poor 2=Fair 3=Good 4=Excellent 0 1 2 3 4 DisCoVisc DuoVisc BioVisc Healon5 AmviscPlus Maintenance Scale
    29. 29. Mean Difficulty of OVD Aspiration 1=Very Easy 2=Easy 3=Neither Easy or Difficult 4=Difficult 5=Very Difficult 0 1 2 3 4 5 DisCoVisc DuoVisc BioVisc Healon5 AmviscPlus Difficulty Level
    30. 30. Mean Effectiveness of Pupil Expansion 1=Not Effective 2=Moderately Effective 3=Very Effective 0 1 2 3 DisCoVisc DuoVisc BioVisc Healon5 AmviscPlus Effectiveness Level
    31. 31. Mean Intraocular Pressure 1 Day Postoperatively 0 5 10 15 20 DisCoVisc DuoVisc BioVisc Healon5 AmviscPlus mmHg
    32. 32. Percent ECC Loss by Cataract Grade: Preop to 2 Month Postop -10 0 10 20 30 40 1 2 3 4 Cataract Grade Percent DisCoVisc DuoVisc BioVisc Healon5 Amvisc Plus
    33. 33. Note: No statistical difference exists (p = 0.5489) in % ECC loss by cataract grade. (p = 0.5489)
    34. 34. 2 Months Postop: % ECC Loss by CDE Level (All OVDs) 0 10 20 30 40 50 <5.0 >5 to <10 >10 to <15 >15 to <20 >20 CDE Range % ECC Loss
    35. 36. MCTo ECC: 8% < ToSt / 16% < Trphaco MCTo Pach: >< ToSt / 16% < Trphaco 9.6% 8.9% 8.1% 5.2% 4.0% 4.1% 0.0% 2.0% 4.0% 6.0% 8.0% 10.0% LONGITUD. (106 Surgeries) TORSIONAL (102 Surgeries) TORS'L+ULTRA (102 Surgeries) Patient Outcome Parameter Comparison Pachymetry (% increase in thickness) Endothelium Cell Loss (% cell loss)
    36. 37. TORSIONAL VS LINEAR <ul><li>Literature : Less Ultrasound energy and BSS used during phaco diminishes the risk for endothelial cell loss and corneal burns </li></ul><ul><li>Ernest P, Rhem M, Mc Dermott M et al. Phacoemulsification conditions resulting in thermal wound injury. J Cataract Refract Surg 2001; 27:1829-1839 </li></ul><ul><li>DeBry P, Olson RJ, Candall AS. Comparison of energy required for phaco chop and divide and conquer phacoemulsification. J Cataract Refract Surg 1998; 24:689-692 </li></ul><ul><li>Dick HB, Kohen T, Jacobi FK, et al. Long term endothelial cell loss folowing phacoemulsification through a temporal clear corneal incision. J. Cataract Refract Surg 1996; 22:63-71 </li></ul>

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