Löw M., Bühler C., Mester U.

Department of Ophthalmology, Bundesknappschafts Hospital, An der Klinik 10, D-66280 Sulzbach

Objective: To determine the efficacy of 3 viscoelastics of different viscosity in preventing early postoperative complications after trabeculectomy (TE) and phaco-trabeculectomy (PT).
Methods: 171 eyes of 149 consecutive patients underwent TE or PT between August 1998 and August 2000. In all cases either Healon® (group 1), Healon GV® (group 2), or Healon 5® (group 3) was instilled into the anterior chamber at the beginning of the operation without removing it at the end of surgery. First IOP assessment was performed after 4 hours. Minimal follow up time was 3 months.
Results: 4 h postoperatively the mean IOP in all groups was below 13mmHg (preoperatively 27.4mmHg) and did not rise above 13mmHg within the first postoperative week. Postoperative IOP-spikes did not occur in any group. We found Healon® detectable in the anterior chamber up to 4 days, Healon GV® up to 6 days, and Healon 5® up to 9 days after surgery. The characteristic early postoperative complications, such as shallow AC, hyphema, bleb failure, iris-corneal-touch, and choroidal detachment were not observed in our patients. In 3.5 -13.6% of all patients we found subtle blood remnants in the AC, but no hyphema. Fibrinous exudation was only to be found after PT in 9.5 - 14% of the eyes.
Conclusion: The protective effect of viscoelastic substances in TE and PT was proved. Viscoelastics, even of a higher viscosity, do not lead to IOP rise in the early postoperative period, despite the anterior chamber being completely filled with the viscoelastic at the end of surgery. The reduction of early postoperative complications is comparable for all viscoelastics investigated.

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