Comparative analysis of anterior chamber stability with a cohesive ophthalmic viscosurgical device versus the soft-shell technique.

Purpose: To study the properties of different ophthalmic viscosurgical devices (OVD) in respect of their ability to create and maintain high intraocular pressure (IOP) during the creation of a continuous curvilinear capsulorhexis (CCC).

Methods: In this randomized interventional study IOP was measured using rebound tonometry with sterilized probes immediately before the beginning of the CCC and immediately afterwards during cataract surgery. The study included 177 eyes in four groups using two different OVD - hyaluronic acid (HA) and a combination of HA and hydroxy propylmethylcellulosis (HPMC) according to the soft shell-technique (SST) - and two different instruments, Utrata forceps (UF) and 26 g cystotome (RN).

Results: The drop in intraocular pressure (IOP) during capsulorhexis was measured at 57.0 ± 12.2 mmHg in eyes treated with HA (90) and 63.1 ± 13.4 mmHg in eyes treated with SS (87). The difference in IOP reduction between HA and SS did not reach statistical significance (p = 0.060).

Conclusions: The use of different OVD did not result in a significant difference in IOP drop. As the soft shell-technique has shown superiority in respect of endothelial protection, these results should encourage cataract surgeon to resort to the soft shell-technique more often if not use it as a standard technique.