Outcomes of a Dispersive Ophthalmic Viscosurgical Device

Objectives: The aim of this study was to evaluate clinical outcomes related to the protection of corneal endothelial cells and the safety of the Bio-Hyalur CS (Biotech Healthcare Group, Luzern, Switzerland) ophthalmic viscosurgical device (OVD) in routine cataract surgery. Methods: Patients who had undergone cataract surgery using Bio-Hyalur CS as an OVD and who had at least 3 months of follow-up data were included in the study. Endothelial cell density (ECD) and morphology (hexagonality, area, and coefficient of variation in cell size) as well as intraocular pressure were evaluated during 3 months of follow-up. Intraoperative and postoperative complications were recorded. Results: Sixty eyes of 44 patients were included in the study. The mean preoperative ECD was 2383.5±288.67 cells/ mm2 . The mean postoperative ECD was 2186.0±359.65 cells/mm2 and 2149.7±354.49 cells/mm2 at 1- and 3-month visits, respectively. The mean coefficient of variation in cell size was 29.1±5.04% and 30.9±5.79% at preoperative and postoperative 3-month visits, respectively. The mean cell area was 426.1±52.59 µm2 and 476.6±122.26 µm2 at preoperative and postoperative 3-month visits, respectively. No adverse events were reported during the study period. Conclusion: Bio-Hyalur CS provided good endothelial protection and has a favorable safety profile. However, comparative studies with other OVDs are necessary.


1.Anger C, Lally JM. Acanthamoeba: A review of its potential to cause keratitis, current lens solution disinfection standards and methodologies and strategies to reduce patient risk. Eye Contact Lens 2008;34:247–53.

2. Visvesvara GS. Free-living pathogenic amoeba. In: Lennette EH, Balows A, Hausler WJ Jr, editors. Manual of Clinical Microbiology. 3rd ed. Washington, DC: American Society of Microbiology 1980. p. 704–8.

3. Naginton J, Watson PG, Playfair TJ, McGill J, Jones BR, Steele AD. Amoebic infection of the eye. Lancet 1974;2:1537–40.

4. Dart JK, Saw VP, Kilvington S. Acanthamoeba keratitis: Diagnosis and treatment update 2009. Am J Ophthalmol 2009;148:487– 99.e2.

5. Radford CF, Bacon AS, Dart JK, Minassian DC. Risk factors for acanthamoeba keratitis in contact lens users: A case-control study. BMJ 1995;310:1567–70.

6. Schaumberg DA, Snow KK, Dana MR. The epidemic of Acanthamoebakeratitis:Where do we stand? Cornea 1998;17:3–10.

7. Farhat B, Sutphin JE. Deep anterior lamellar keratoplasty for acanthamoeba keratitis complicating the use of Boston scleral lens. Eye Contact Lens 2014;40:e5–7.

8. Yamazaki N, Kobayashi A, Yokogawa H, Ishibashi Y, Oikawa Y, Tokoro M, et al. In Vivo Imaging of Radial Keratoneuritis in Patients with Acanthamoeba keratitis by Anterior-Segment Optical Coherence Tomography. Ophthalmology 2014;121:2153–8.

9. Pullum KW, Whiting MA, Buckley RJ. Scleral contact lenses: The expanding role. Cornea. 2005;24:269–77.

10. Segal O, Barkana Y, Hourovitz D, Behrman S, Kamun Y, Avni I, et al. Scleral contact lenses may help where other modalities fail. Cornea 2003;22:308–10.

11. Romero-Rangel T, Stavrou P, Cotter J, Rosenthal P, Baltatzis S, Foster CS. Gas-permeable scleral contact lens therapy in ocular surface disease. Am J Ophthalmol 2000;130:25–32.

12. Fleiszig SM, Evans DJ. Pathogenesis of contact lens-associated microbial keratitis. Optom Vis Sci 2010;87:225–32.

13. Zimmerman AB, Marks A. Microbial keratitis secondary to unintended poor compliance with scleral gas-permeable contact lenses. Eye Contact Lens 2014;40:e1–4.

14. Jacobs DS, Rosenthal P. Boston scleral lens prosthetic device for treatment of severe dry eye in chronic graft-versus-host disease. Cornea 2007;26:1195–9.

15. Rosenthal P, Cotter JM, Baum J. Treatment of persistent corneal epithelial defect with extended wear of a fluid-ventilated gas-permeable scleral contact lens. Am J Ophthalmol 2000;130:33–41.

16. Baran I, Bradley JA, Alipour F, Rosenthal P, Le HG, Jacobs DS. PROSE treatment of corneal ectasia. Cont Lens Anterior Eye 2012;35:222–7.

17. Panjwani N. Pathogenesis of Acanthamoeba keratitis. Ocul Surf 2010;8:70–9.

18. Cao Z, Saravanan C, Goldstein MH, Wu HK, Pasricha G, Sharma S, et al. Effect of human tears on Acanthamoeba- induced cytopathic effect. Arch Ophthalmol 2008;126:348–52.

19. McClellan K, Howard K, Niederkorn JY, Alizadeh H. Effect of steroids on Acanthamoeba cysts and trophozoites. Invest Ophthalmol Vis Sci 2001;42:2885–93.

20. Por YM, Mehta JS, Chua JL, Koh TH, Khor WB, Fong AC, et al. Acanthamoeba keratitis associated with contact lens wear in Singapore. Am J Ophthalmol 2009;148:7–12.e2.

21. Sunada A, Kimura K, Nishi I, Toyokawa M, Ueda A, Sakata T, et al. In Vitro Evaluations of Topical Agents to Treat Acanthamoeba Keratitis. Ophthalmology 2014;121:2059–65.

22. Cabello-Vílchez AM, Martín-Navarro CM, López-Arencibia A, Reyes-Batlle M, Sifaoui I, Valladares B, et all. Voriconazole as a first-line treatment against potentially pathogenic Acanthamoeba strains from Peru. Parasitol Res 2014;113:755–9.

23. Iovieno A, Miller D, Ledee DR, Alfonso EC. Cysticidal activity of antifungals against different genotypes of Acanthamoeba Antimicrob Agents Chemother. Antimicrob Agents Chemother 2014;58:5626–8.

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