Comparison of the effect of sodium hyaluronate (Ophthalin®) and hydroxypropylmethylcellulose (HPMC-Ophtal®) on corneal endothelium, central corneal thickness, and intraocular pressure after phacoemulsification

PURPOSE. To prospectively evaluate the effects of 2% hydroxypropyl-methylcellulose (HPMC-Ophtal((R))) and sodium hyaluronate 1% (Ophthalin((R))) on intraocular pressure, corneal thickness, and endothelial cell loss in small incision cataract surgery with implant. METHODS. A total of 110 patients undergoing routine phacoemulsification with implant received either 2% hydroxypropylmethylcellulose or sodium hyaluronate 1% as ophthalmic viscosurgical device. Pre- and postoperative slit lamp examination, intraocular pressure measurement (preoperatively and at 1-4 hours, 1 day, and 7 days postoperatively), ultrasonic pachymetry (preoperatively and at 1 week, 4-6 weeks, and 12 weeks postoperatively), and corneal endothelial cell count (preoperatively and 12 weeks postoperatively) were performed. Data were analyzed using two-way analysis of variance. RESULTS. All measurements were comparable between the two groups preoperatively, Intraocular pressure was significantly lower in the Ophthalin((R)) group at 1 day postoperatively, while no significant difference was found between the two groups on the 1-4 hours and 7 days examination. The central corneal thickness was not significantly different between the two groups at any postoperative visit. However, the mean cell density demonstrated a significant fall of 11.76% for Ophthalin((R)) and 4.27% for HPMC-Ophtal((R)) at 12 weeks postoperatively, the difference between the two being significant (p=0.009). CONCLUSIONS. 2% Hydroxypropylmethylcellulose, compared with sodium hyaluronate 1%, is superior in protecting the corneal endothelial cells, has the same effect on central corneal thickness, and is associated with slightly higher intraocular pressure 1 day postoperatively. It compares favorably with sodium hyaluronate 1% and can be used as an effective and cheaper alternative in routine small incision cataract surgery with implant.