We evaluated histopathologically the effect of the viscoelastic substance on surgery of the extraocular muscle in the 26 rabbits with 1. 6-2. 5kg of weight. The viscoelastic substances were 1% sodium hyaluronate(Healon) and 2% hydroxypropyl methylcellulose(Methocel), which were introduced between the extraocular muscle and its adjacent tissue on surgery. The rabbits were categorized by group 1(the rabbits with Healon), group 2(with Methocel), and group 3(with normal saline as control). These rabbits were enuclated at 3rd, 7th, 14th, 28th and 56th day following operations, and the eyes were fixed in 2.5% glutaraldehyde solution. The tissue was stained with hematoxylin-eosin and Masson's trichrome, and examined under a light microscope. The results were as follows: 1. In the first group(Healon), the tissue adhesion and degeneration of the muscle were milder than those of control(saline) group. 2. The changes in second group(Methocel) was milder than in the first group and more severe than in control group. 3. It is concluded that 2% Methocel can be used clinically in the surgery of the extraocular muscle.
Glutaral ; Methylcellulose ; Muscles* ; Rabbits ; Sodium ; Tissue Adhesions ; Viscoelastic Substances

Several different viscoelastic substances are widely used in many ophthalmologic fields. In our study, the efficacy and safety of the different kinds of viscoelastics -Healon(R), Provisc(R), Viscorenal(R), Hyal-2000(R), Viscoat(R) and Biolon(R)-was evaluated in undergoing phacoemulsification and posterior intraocular lens implantation, corneal transplantation and ocular trauma surgery. We evaluated and the facility of the injection the foreign materials during injection of viscoelastics through the microscopy. We measured the changes of intraocular pressure at the postoperative 1 day and corneal endothelial cell count at the postoperative 2 month. The mean endothelial cell loss after phacoemulsification and posterior intraocular lens implantation was 13.71% at postoperative 1 day and there was no significantly different among groups. The incidence of the foreign materials including air bubles in viscoelastics in the operating microscope was Provisc(R), Hyal 2000 Viscorneal(R), Biolon(R), Healon(R) in order. The mean incidence of the intraocular pressure above 25 mmHg after cataract surgery at postoperative 1 day was 3.94%and was Hyal 2000(R), Biolon(R), Viscorneal(R), Healon(R), Provisc(R) in order. The incidence of the additional use of the antiglaucoma drugs in keratoplasty patients was 76%in Healon(R) group, 26.7%in Viscoat(R) group, 69.2%in Provisc(R) group respectively. From the results of this report, we conclude that it is desirable to use the proper viscoelastics according to the chemical and physical properties in special situations, but there is no significant difference in the same viscoelastic substance.
Cataract ; Corneal Transplantation ; Endothelial Cells ; Humans ; Incidence ; Intraocular Pressure ; Lens Implantation, Intraocular ; Microscopy ; Phacoemulsification ; Viscoelastic Substances

PURPOSE: To determine whether viscoelastic materials are effective to protect the corneal endothelium from air bubble damage. METHODS: Human eye bank (n=12) and rabbit (n=22) eyes underwent a standardized phacoemulsification procedure with or without viscoelastic material [1% sodium hyaluronate (Healon(R)), 1.4% sodium hyaluronate (Healon GV(R)), 3% sodium hyaluronate with 4% chondroitin sulfate (Viscoat(R))]. The integrity of the endothelium was examined after the procedure with F-actin staining and scanning electron microscopy (SEM). RESULTS: In the phacoemulsification experiment without viscoelastic material, with Healon, and with Healon GV, the endothelium of both human and rabbit corneas had many areas of cell loss in a pattern consistent with air bubble damage. But with Viscoat, endothelial cells remained intact. CONCLUSIONS: We found that Viscoat was effective to protect the endothelium from air bubble damage. Viscoat seems to protect the endothelium by acting as a physical barrier.
Actins ; Chondroitin Sulfates ; Cornea ; Endothelial Cells ; Endothelium ; Endothelium, Corneal ; Eye Banks ; Humans ; Hyaluronic Acid ; Microscopy, Electron, Scanning ; Phacoemulsification* ; Viscoelastic Substances*

When the corneal endothelium is injured by intraocular surgery, corneal edema occurs above the threshold level. Preoperative examination of corneal endothelium is valuable in prediction the degree of transparency of the cornea. We conducted this study to elucidate what factors affect corneal endothelial cells in performing the cataract extraction and IOL insertion and what is necessary to minimize the corneal endothelial damage. We performed pacoemulsification and IOL insertion in guttata patients, and preoperative and postoperative endothelial examination was done by using specuar microscope and pachymeter. Although the mean of endothelial cell density was diminished from 1498.7cells/mm2 to 1301cells/mm2 after operation. visible edema was not detected by slit lamp examination and visual acuity was improved from 0.15 to 0.48. The older the patient`s age, the longer the time of phaceemulsification; as the ages of the patients are increased, postoperative corneal thicknesses were increased and postoperative endothelial cell densities were decreased. The endothelial cells were relatively well preserved after cataract operation in patients of preoperative diminished endothelial cells. We suggest that when performing the cataract operation in patients of decreased endothelial function, one must use appropriate large amount of viscoelastic substances, and minimize phacoemulsification power and time in as short operation time as possible by accurate surgical technique. We also believe that periodic postoperative endothelial examination is necessary in patients with decreased endothelial function.
Cataract Extraction* ; Cataract* ; Cornea ; Corneal Edema ; Edema ; Endothelial Cells* ; Endothelium, Corneal ; Humans ; Phacoemulsification ; Viscoelastic Substances ; Visual Acuity

Osteoarthdtis (OA) is a common, chronic, and painful disorder characterized by cartilage loss. It is the most common among all rheumatic disorders and is a major cause of disability. OA can be managed with a variety of pharmacological therapies, including acetaminophen, traditional nonsteroidal antiinflammatory drugs, cyclooxygenase2 inhibitors, intraarticular steroids, viscosupplements, glucosamine, chondroitin sulfate, and capsaicin. In this review, I describe the clinical efficacy and side effects of these pharmaceuticals and review diseasemodifying osteoarthritis drugs (DMOAD), such as glucosamine, diacerein, and avocado/soybean unsaponifiables, of which the clinical efficacy still remains to be determined.
Acetaminophen ; Capsaicin ; Cartilage ; Chondroitin Sulfates ; Glucosamine ; Osteoarthritis* ; Steroids ; Viscosupplements

The viscoelastic properties of four novel, low molecular weight hyaluronic acid derivatives were investigated and compared to the parent hyaluronic acid compound. Briefly, all derivatives were synthesized by first deacetylating the parent hyaluronic acid. One sample was left as such, while two others were reacytelated. The final compound, of particular interest for its anti-inflammatory properties, was butyrylated. The compounds were dissolved in phosphate buffer solution (PBS) and studied at a concentration of 5 mg/mL. Shear thinning behaviour was observed for all compounds, however, derivative samples had a lower viscosity than the parent compound at high shear rates. Viscoelastic properties were also observed to decrease as a result of the derivative preparation method. It is believed that these changes are primarily caused by a decrease in hyaluronic acid molecular weight. By increasing the concentration of the anti-inflammatory compound, it may be possible to modulate the viscoelastic properties to more closely resemble those of commercial viscosupplements. As a result, an anti-inflammatory derivative of hyaluronic acid may potentially improve upon existing viscosupplements used to treat patients who are susceptible to flare up.
Humans ; Hyaluronic Acid* ; Methods ; Molecular Weight ; Osteoarthritis ; Parents ; Viscosity ; Viscosupplements

BACKGROUND: The aim of this study is to test if adjuvant hydrotherapy with viscosupplement is beneficial on management of pain, stiffness, function, and mental relaxation in knee osteoarthritis (OA). METHODS: Nineteen patients with OA were randomly assigned to hydrotherapy or control groups. All patients received viscosupplement injections once a week for 3 weeks. Hydrotherapy group (n=9) had a spa containing green tea, 3 days a week for 2 weeks. The control group (n=10) received only injections. All patients were assessed at baseline and after the third injection. All were assessed for pain (visual analog scale, VAS), pain severity, and functional status (Western Ontario and McMaster Universities osteoarthritis index, WOMAC), emotional status, quality of life (Euro quality of life health-related quality of life inventory five dimension, EQ-5D), and relative spectral power of alpha waves in electroencephalography (EEG). RESULTS: Both groups reported a statistically significant reduction of pain at the end of treatment and detailed assessment of pain, and function in WOMAC and the relative power of alpha in electroencephalogram showed statistical significant difference only in the hydrotherapy group. However, there were no significant intergroup differences, except for VAS score. CONCLUSION: Adjuvant 2-week hydrotherapy to viscosupplement might have a modest role in the management of pain and functional disability and the mental relaxation in patients with knee OA. Larger, randomized controlled trials with intervention of long term period to determine efficacy in treating knee OA are warranted.
Electroencephalography ; Humans ; Hydrotherapy* ; Knee ; Ontario ; Osteoarthritis ; Osteoarthritis, Knee* ; Quality of Life ; Relaxation* ; Tea ; Viscosupplements

Osteoarthritis is a common but often difficult problem to manage. Nonsurgical management, consisting of lifestyle modification, physical therapy and pharmacologic therapy (e.g., analgesics, anti-inflammatory medications), is often ineffective or leaves residual symptoms. Viscosupplementation is a newly available option for patients with symptomatic knee osteoarthritis that involves a series of intra-articular injections of hyaluronic acid. The exact mechanism of action is unclear, although increasing the viscoelasticity of the synovial fluid appears to play a role. The exact indications for viscosupplementation are still evolving, but it currently can be considered for use in patients who have significant residual symptoms despite traditional nonpharmacologic and pharmacologic treatments. In addition, patients who are intolerant of traditional treatments (e.g., gastrointestinal problems related to anti-inflammatory medications) can be considered for these injections.
Anti-Inflammatory Agents, Non-Steroidal ; Humans ; Hyaluronic Acid* ; Injections, Intra-Articular ; Life Style ; Osteoarthritis ; Osteoarthritis, Knee ; Synovial Fluid ; Viscosupplementation ; Viscosupplements

No abstract available.
Adult ; Female ; Glaucoma, Angle-Closure/*surgery ; Humans ; Intraocular Pressure/physiology ; *Iridectomy ; Iris/*surgery ; Laser Therapy/*methods ; Lens, Crystalline/*physiology ; Middle Aged ; Suture Techniques ; Tonometry, Ocular ; Viscosupplements/administration & dosage

PURPOSE: Controversies remain surrounding the choice of hyaluronic acid products and patient selection. A study was conducted to report the long-term survivorship of intra-articular injection effect of high molecular weight hyaluronic preparation hylan GF-20 (Synvisc-One) for patients with symptomatic knee osteoarthritis. MATERIALS AND METHODS: A retrospective observational analysis of a single therapeutic series was carried out. The analysis was conducted to determine therapeutic effect survivorship taking arthroplasty and any other surgical interventions as endpoint results. RESULTS: Seventy-seven consecutive patients (82 knees) were followed up for five years. At one-year follow-up, 71 knees (87%) responded to treatment and only 8 knees (10%) were offered arthroplasty due to persistence of symptoms. At five-year follow-up, 41 (50%) were still considered responders. During the study period, repeat injection was given in 9 knees (11%). Arthroplasty (either total or unicompartmental) was required in 26 (31%). Kaplan-Meier survivorship analysis of therapeutic effect demonstrated 67% survival at 5 years with arthroplasty as endpoint and 58% survival at 5 years with all secondary interventions as endpoint. CONCLUSIONS: This study demonstrates a significantly longer duration of clinical benefit of hylan GF-20 injection. Present results may suggest a notion of an ideal delay therapeutic strategy for patients not ready to receive an arthroplasty. Further studies will be required to help characterise these subsets of patients.
Arthroplasty ; Follow-Up Studies ; Humans ; Hyaluronic Acid ; Injections, Intra-Articular ; Knee ; Molecular Weight ; Osteoarthritis ; Osteoarthritis, Knee ; Patient Selection ; Retrospective Studies ; Survival Rate ; Treatment Outcome ; Viscosupplementation ; Viscosupplements