A proteção endotelial na facectomia: avaliação de nova substância visco-elástica sintética

Soares, Emyr Francisco

doi:10.5935/0004-2749.19990061

RESUMO

Objetivo:

Avaliar a segurança clínica e eficiência de nova solução visco-elástica sintética - MEDILON (poliacrilamida).

Métodos:

60 pacientes foram aleatoriamente divididos em 3 grupos de 20 pacientes e submetidos à facectomia extra-capsular. Como proteção endotelial foram utilizados os seguintes: Grupo 1 - AR, Grupo 2 - HEALON (hialuronato de sódio), e Grupo 3 - MEDILON (poliacrilamida). Exames pré e pós-operatórios (1 dia e 3 meses) avaliaram comparativamente a contagem de células endoteliais, variação da pressão intra-ocular, paquimetria corneana, tipo de incisão, complicações pós-operatórias e impressões subjetivas dos cirurgiões.

Resultados:

A perda de células endoteliais foi equivalente entre os Grupos 2 (Healon) e Grupo 3 (Medilon), e maior no Grupo 1 (ar). Em todos outros aspectos clínicos estudados não houve diferenças estatisticamente significativas entre o Grupo 2 e o Grupo 3. Quanto à impressão subjetiva dos cirurgiões verificou-se uma discreta preferência pela poliacrilamida sobre o hialuronato de sódio.

Conclusões:

Os resultados sugerem que a poliacrilamida é comparável ao hialuronato de sódio quanto à segurança clínica e eficiência como solução visco-elástica para uso intra-ocular.

Palavras-chave:
Proteção encdotelial; Poliacrilamida; Hialuronato de sódio; Visco-elásticos

SUMMARY

Purpose:

To evaluate the clinical safety and effectiveness of the novel synthetic viscoelastic solution MEDILON (polyacrylamide).

Methods:

60 cataract patients were randomly divided into 3 groups of 20 patients. Upon extracapsular cataract extraction Group 1 received injected air in the anterior chamber for endothelium protection, Group 2 received HEALON ( sodium hyaluronate) and Group 3 received MEDILON (polyacrylamide). Preoperative and postoperative ( 1 day and 3 months) examinations were conducted as well as a comparative study between groups evaluating endothelial cell count, intraocular pressure variation, corneal thickness, incision type, postoperative complications and surgeons' subjective impressions.

Results:

Endothelial cell loss was similar in Group 2 (Healon) and Group 3 (Medilon), and higher in Group 1 (Air). Regarding all other clinical aspects there were no statistically significant differences between Groups 2 and 3. As to the surgeons subjective impressions there was a discreet preference for polyacrylamide over sodium hyaluronate.

Conclusions:

Our results suggest that the clinical safety and effectiveness of polyacrylamide as a viscoelastic substance for intraocular use is comparable to sodium hyaluronate.

Keywords:
Endothelial protection; Polyacrilamide; Sodium hyaluronate; Viscoelastics

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REFERÊNCIAS BIBLIOGRÁFICAS

¹
Pape LG, Balazs EA. The use of sodium hyaluronate (Healon) in human anterior segment surgery. Ophthalmology 1980;87:699-705.
²
Graue EL, Polack FM, Balazs EA. The protective effect of sodium hyaluronate to corneal endothelium. Exp Eye Res 1980;31:119-27.
³
Polack FM. Healon (Na hyaluronate). A review of the literature. Cornea 1986;5:81-93.
⁴
Boume WM, Kaufman HE. Endothelial damage associated with intraocular lenses. Am J Ophthalmol 1976;81:482-5.
⁵
Perrit RA. The use of Healon in anterior chamber lens implantation. Am Intraocul Implant Soc J 1982;8:55-8.
⁶
Bourne WM, Liesegang TJ, Walter RR et al. The effect of sodium hyaluronate on endothelial cell damage during extracapsular cataract extraction and posterior chamber lens implantation. Am J Ophtalmol 1984;98:759-65.
⁷
Holmberg AS, Philipson BT. Sodium hyaluronate in cataract surgery. 1. Report on the use of Healon in two different types of intracapsular cataract surgery. Ophthalmology 1984;91:45-52.
⁸
Idem: Sodium hyaluronate in cataract surgery, 2. Report on the use of Healon in extracapsular cataract surgery using phacoemulsification. Ibid: 53-9.
⁹
Alpar JJ. Comparison of Healon and Amvisc. Ann Ophthalmol 1985;17:647-51.
¹⁰
Percival SPB. Results of a clinical trial of sodium hyaluronate in lens implantaion surgery. Am Intraocul lmplant Soc J 1985;1 1:257-9.
¹¹
Sharpe ED, Simmons RJ. A prospective comparison of Amvisc and Healon in cataract surgery. J Cataract Refractive Surg 1986;12:47-9.
¹²
Percival SPB. Complications from use of sodium hyaluronate (Healonid) in anterior segment surgery. Brit J Ophthalmol 1982;66:714-6.
¹³
Barron BA, Busin M, Page C et al. Comparison of the effect of Viscoat and Healon on postoperative intraocular pressure. Am J Ophthalmol 1985;100:377-84.
¹⁴
Embriano PG. Postoperative pressures after phacoemulsification: sodium hyaluronate vs. Sodium condroitin sulphate-sodium hyaluronate. Ann Ophthalmol 1989;21:85-90.
¹⁵
Olivius E, Thorburn W. Intraocular pressure after cataract surgery with Healon. Am Intraocul Implant Soc J 1985;11:480-2.
¹⁶
Roberts B, Peiffer RL. Experimental evaluation of a synthetic viscoelastic material on intraocular pressure and corneal endothelium. J Cataract Refract Surg 1989;15:321-6.
¹⁷
Pape LG. Intracapsular and extracapsular of lens technique of lens implantation with Healon. Am Intraocul Implant Soc J 1980;6:342-3.
¹⁸
Miller D, Stegmann R. The use of Healon in intraoeular lens implantation. Int Ophthalmol Clin 1982;22:177-187.
¹⁹
Frey LL. Postoperative intraoeular pressure rises: a comparison of Healon, Amvisc and Viscoat. J Cataract Refract Surg 1989;15:415-20.
²⁰
Lindquist DT, Edenfield B. Citotoxicity of viscoelastics on cultured corneal epithelial cells measured by plasminogen activator release. J Córnea Surg 1944;10:95-102.
²¹
Vilias-Boas ML. Ação do alil-sulfonato de sódio na câmara anterior do olho do coelho. Estudo biomicroscópico, tonométrico, citológico, histológico e de microscopia especular.SS Tese de Doutoramento apresentada ao Instituto Hilton Rocha. Aprovada com louvor 1988.

Datas de Publicação

Publicação nesta coleção
Fev 1999

Este é um artigo publicado em acesso aberto (Open Access) sob a licença Creative Commons Attribution, que permite uso, distribuição e reprodução em qualquer meio, sem restrições desde que o trabalho original seja corretamente citado.

[1] ¹
Pape LG, Balazs EA. The use of sodium hyaluronate (Healon) in human anterior segment surgery. Ophthalmology 1980;87:699-705.

[2] ²
Graue EL, Polack FM, Balazs EA. The protective effect of sodium hyaluronate to corneal endothelium. Exp Eye Res 1980;31:119-27.

[3] ³
Polack FM. Healon (Na hyaluronate). A review of the literature. Cornea 1986;5:81-93.

[4] ⁴
Boume WM, Kaufman HE. Endothelial damage associated with intraocular lenses. Am J Ophthalmol 1976;81:482-5.

[5] ⁵
Perrit RA. The use of Healon in anterior chamber lens implantation. Am Intraocul Implant Soc J 1982;8:55-8.

[6] ⁶
Bourne WM, Liesegang TJ, Walter RR et al. The effect of sodium hyaluronate on endothelial cell damage during extracapsular cataract extraction and posterior chamber lens implantation. Am J Ophtalmol 1984;98:759-65.

[7] ⁷
Holmberg AS, Philipson BT. Sodium hyaluronate in cataract surgery. 1. Report on the use of Healon in two different types of intracapsular cataract surgery. Ophthalmology 1984;91:45-52.

[8] ⁸
Idem: Sodium hyaluronate in cataract surgery, 2. Report on the use of Healon in extracapsular cataract surgery using phacoemulsification. Ibid: 53-9.

[9] ⁹
Alpar JJ. Comparison of Healon and Amvisc. Ann Ophthalmol 1985;17:647-51.

[10] ¹⁰
Percival SPB. Results of a clinical trial of sodium hyaluronate in lens implantaion surgery. Am Intraocul lmplant Soc J 1985;1 1:257-9.

[11] ¹¹
Sharpe ED, Simmons RJ. A prospective comparison of Amvisc and Healon in cataract surgery. J Cataract Refractive Surg 1986;12:47-9.

[12] ¹²
Percival SPB. Complications from use of sodium hyaluronate (Healonid) in anterior segment surgery. Brit J Ophthalmol 1982;66:714-6.

[13] ¹³
Barron BA, Busin M, Page C et al. Comparison of the effect of Viscoat and Healon on postoperative intraocular pressure. Am J Ophthalmol 1985;100:377-84.

[14] ¹⁴
Embriano PG. Postoperative pressures after phacoemulsification: sodium hyaluronate vs. Sodium condroitin sulphate-sodium hyaluronate. Ann Ophthalmol 1989;21:85-90.

[15] ¹⁵
Olivius E, Thorburn W. Intraocular pressure after cataract surgery with Healon. Am Intraocul Implant Soc J 1985;11:480-2.

[16] ¹⁶
Roberts B, Peiffer RL. Experimental evaluation of a synthetic viscoelastic material on intraocular pressure and corneal endothelium. J Cataract Refract Surg 1989;15:321-6.

[17] ¹⁷
Pape LG. Intracapsular and extracapsular of lens technique of lens implantation with Healon. Am Intraocul Implant Soc J 1980;6:342-3.

[18] ¹⁸
Miller D, Stegmann R. The use of Healon in intraoeular lens implantation. Int Ophthalmol Clin 1982;22:177-187.

[19] ¹⁹
Frey LL. Postoperative intraoeular pressure rises: a comparison of Healon, Amvisc and Viscoat. J Cataract Refract Surg 1989;15:415-20.

[20] ²⁰
Lindquist DT, Edenfield B. Citotoxicity of viscoelastics on cultured corneal epithelial cells measured by plasminogen activator release. J Córnea Surg 1944;10:95-102.

[21] ²¹
Vilias-Boas ML. Ação do alil-sulfonato de sódio na câmara anterior do olho do coelho. Estudo biomicroscópico, tonométrico, citológico, histológico e de microscopia especular.SS Tese de Doutoramento apresentada ao Instituto Hilton Rocha. Aprovada com louvor 1988.

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