Articles Vol. 67 No. 4 25/04/2026

EVALUATION OF THE PROTECTIVE EFFECT OF MANNITOL-CONTAINING OPHTHALMIC VISCOSURGICAL DEVICES ON CORNEAL ENDOTHELIAL CELLS DURING PHACOEMULSIFICATION IN PATIENTS WITH LOW ENDOTHELIAL CELL DENSITY

Nguyen Huynh Phuc1,2, Le Ngoc Hung3,4, Hoang Trung Kien1,2, Phan Van Nam5,6
1 Saigon Vinh Eye Hospital
2 Bệnh viện Mắt Sài Gòn Vinh
3 Gia Dinh People’s Hospital
4 Bệnh viện Nhân Dân Gia Định
5 Hue University of Medicine and Pharmacy
6 Trường Đại học Y Dược, Đại học Huế
DOI: 10.52163/yhc.v67i4.4886
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Keywords
Cataract, intraocular mucus, mannitol.
Abstract

Objective: To evaluate the safety and corneal endothelial protective efficacy of a mannitol-containing ophthalmic viscosurgical device during phacoemulsification for cataract surgery in patients with low corneal endothelial cell density.

Methods: This randomized controlled trial included cataract patients indicated for phacoemulsification with preoperative endothelial cell density ranging from 1000 to 2000 cells/mm² at Saigon Vinh Eye Hospital from October 2024 to May 2025. Patients were randomly assigned to three groups: group A received an ophthalmic viscosurgical device containing 2% sodium hyaluronate combined with 0.5% mannitol; group B received an ophthalmic viscosurgical device containing 1.4% sodium hyaluronate; and group C received an ophthalmic viscosurgical device containing 2.4% hydroxypropyl methylcellulose. Endothelial cell density and morphology, central corneal thickness, and best-corrected visual acuity were assessed preoperatively and at 1 week, 1 month, and 3 months postoperatively.

Results: At 1 week postoperatively, group A demonstrated significantly higher endothelial cell density, lower coefficient of variation, higher percentage of hexagonal cells, and lower central corneal thickness compared with the other two groups (p < 0.05). Postoperative visual acuity improved more markedly in group A. By 1 month, corneal edema had largely resolved in all groups, and intergroup differences in visual acuity were no longer statistically significant.

Conclusions: Ophthalmic viscosurgical device containing sodium hyaluronate 2% and mannitol 0.5% provides superior corneal endothelial protection during phacoemulsification in patients with low preoperative endothelial cell density, contributing to reduced postoperative corneal edema and faster early visual recovery postoperatively

References
[1]
Chen H.C et al. Accelerated corneal endothelial cell loss after phacoemulsification in patients with mildly low endothelial cell density. Journal of Clinical Medicine, 2021, 10 (11): 2270. doi: 10.3390/jcm10112270 Google Scholar
[2]
Hayashi K et al. Cataract surgery in eyes with low corneal endothelial cell density. Journal of cataract and refractive surgery, 2011, 37 (8): 1419-25. doi: 10.1016/j.jcrs.2011.02.025 Google Scholar
[3]
Cameron M.D et al. Identification of free radicals produced during phacoemulsification. Journal of cataract and refractive surgery, 2001, 27 (3): 463-470. doi: 10.1016/s0886-3350(00)00643-x Google Scholar
[4]
Igarashi T et al. Hydrogen prevents corneal endothelial damage in phacoemulsification cataract surgery. Scientific reports, 2016, 6: 31190. doi: 10.1038/srep31190 Google Scholar
[5]
Mahdy M.A et al. Relationship between endothelial cell loss and microcoaxial phacoemulsification parameters in noncomplicated cataract surgery. Clinical ophthalmology (Auckland, NZ), 2012, 6: 503-10. doi: 10.2147/opth.S29865 Google Scholar
[6]
Belda J.I et al. Hyaluronic acid combined with mannitol to improve protection against free-radical endothelial damage: experimental model. Journal of cataract and refractive surgery, 2005, 31 (6): 1213-8. doi: 10.1016/j.jcrs.2004.11.055 Google Scholar
[7]
Ben-Eliahu S et al. Protective effect of different ophthalmic viscosurgical devices on corneal endothelial cells during phacoemulsification: rabbit model. Journal of cataract and refractive surgery, 2010, 36 (11): 1972-5. doi: 10.1016/j.jcrs.2010.05.023 Google Scholar
[8]
Borkenstein A.F et al. Ophthalmic viscosurgical devices (OVDs) in challenging cases: a review. Ophthalmology and therapy, 2021, 10 (4): 831-843. doi: 10.1007/s40123-021-00403-9 Google Scholar
[9]
Singh M et al. Corneal endothelial protection during manual small-incision cataract surgery: A narrative review. Indian journal of ophthalmology, 2022, 70 (11): 3791-3796. doi: 10.4103/ijo.IJO_1048_22 Google Scholar
[10]
Palacio-Pastrana C et al. Evaluation of the rheological properties, preclinical safety, and clinical effectiveness of a new dispersive ophthalmic viscoelastic device for cataract surgery. Medical devices (Auckland, NZ), 2022, 15: 293-305. doi: 10.2147/mder.S379050 Google Scholar
[11]
Watanabe I et al. Rheological and adhesive properties to identify cohesive and dispersive ophthalmic viscosurgical devices. Chemical & Pharmaceutical Bulletin, 2019, 67 (3): 277-283. doi: 10.1248/cpb.c18-00890 Google Scholar
[12]
Labiris G et al. Cohesive versus dispersive-cohesive ophthalmic viscosurgical device in torsional intelligent phaco. Journal of Cataract and Refractive Surgery, 2015, 41: 681-2. doi: 10.1016/j.jcrs.2015.01.010 Google Scholar
[13]
Unsal U et al. Intraocular lens implantation without the use of ophthalmic viscosurgical device. International ophthalmology, 2017, 37 (1): 25-30. doi: 10.1007/s10792-016-0211-x Google Scholar
[14]
Mohammadpour M et al. Physical characteristics, clinical application, and side effects of viscoelastics in ophthalmology. Journal of Current Ophthalmology, 2023, 35 (4): 313-319. doi: 10.4103/joco.joco_178_23. Google Scholar