Glutathione (GSH and GSSG) is one of the body’s natural antioxidants. Free-radicals (by-products of oxidation) are capable of inflicting serious damage to the corneal endothelium and other delicate intraocular structures during ophthalmic surgery. There is evidence to suggest that glutathione is an effective free-radical scavenger. Glutathione also maintains the junctional complexes of corneal endothelial cells1 and protects the integrity of the blood-aqueous barrier.2 The tissues within the eye are highly sensitive to depletion of cellular glutathione levels. Depletion of cellular glutathione can result in cell apoptosis.3 BSS PLUS® Irrigating Solution has the ability to deliver a continuous supply of glutathione to the surgical site.

BSS PLUS® Irrigating Solution

Sodium bicarbonate is the body’s natural buffer. It is the major ion in the formation of aqueous humor and is vital for maintaining the blood-aqueous barrier. Sodium bicarbonate is also essential for maintaining retinal function. Studies have shown that omission of bicarbonate leads to significant alterations in both light-induced ERG potentials4 and metabolism of the isolated rat retina.5

Dextrose is the primary energy source of cellular function. Dextrose helps maintain transparency of the cornea and lens and is critical for maintaining optimal retinal functions. Endothelial and retinal cells can rapidly become stressed or compromised when deprived of nourishment. Other intraocular irrigating solutions do not contain the ions, nutrients, and substrates necessary to sustain healthy, normal functioning of ocular tissues. This is why a complete perfusion solution makes good sense in ocular procedures.

Chemical Composition Comparison

Ingredient Human
Sodium 162.9 144 102 160.0 155.7
Potassium 2.2–3.9 5.5 4 5.0 10.1
Calcium 1.8 1.6 3 1.0 3.3
Magnesium 1.1 1.3 - 1.0 1.5
Chloride 131.6 177.0 - 130.0 128.9
Bicarbonate 20.15 15.0 - 25.0 -
Phosphate 0.62 0.4 - 3.0 -
Lactate 2.5 7.8 28 - -
Glucose 2.7–3.7 3.4 - 5.0 -
Ascorbate 1.06 2.0 - - -
Glutathione 0.0019 - - 0.3 -
Citrate - - - - 5.8
Acetate - - - - 28.6
pH 7.38 - 6.0–7.2 7.4 7.6
304 - 277 305 298

Chemical composition of human aqueous humor, vitreous humor, BSS PLUS® Irrigating Solution and BSS® irrigating solution (all concentrations expressed in mmol/L or mEq/L solution)6

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Important information about BSS PLUS® Irrigating Solution

Description: BSS PLUS® a sterile intraocular irrigating solution is used during all intraocular surgical procedures, including those requiring a relatively long intraocular perfusion time (e.g., pars plana vitrectomy, phacoemulsification, extracapsular cataract extraction/lens aspiration, anterior segment reconstruction, etc.). The solution does not contain a preservative and should be prepared just prior to use in surgery.

Indications and Usage: BSS PLUS® Irrigating Solution is indicated for use as an intraocular irrigating solution during intraocular surgical procedures involving perfusion of the eye.

Contraindications: There are no specific contraindications to the use of BSS PLUS® Irrigating Solution; however, contraindications for the surgical procedure during which BSS PLUS® Irrigating Solution is to be used should be strictly adhered to.

Warnings: For IRRIGATION during ophthalmic surgery only. Not for injection or intravenous infusion. Do not use unless product is clear, seal is intact, vacuum is present and container is undamaged. Do not use if product is discolored or contains a precipitate.

Precautions: DO NOT USE BSS PLUS® IRRIGATING SOLUTION UNTIL PART I IS FULLY RECONSTITUTED WITH PART II. Discard unused contents. BSS PLUS® Irrigating Solution does not contain a preservative; therefore, do not use this container for more than one patient. Do not use additives other than BSS PLUS® Irrigating Solution Concentrate Part II (20 mL) with this product. Tissue damage could result if other drugs are added to product. DISCARD ANY UNUSED PORTION SIX HOURS AFTER PREPARATION. Studies suggest that intraocular irrigating solutions which are iso-osmotic with normal aqueous fluids should be used with caution in diabetic patients undergoing vitrectomy since intraoperative lens changes have been observed. There have been reports of corneal clouding or edema following ocular surgery in which BSS PLUS® Irrigating Solution was used as an irrigating solution. As in all surgical procedures appropriate measures should be taken to minimize trauma to the cornea and other ocular tissues.

Geriatric Use: No overall differences in safety or effectiveness have been observed between elderly and younger patients.

Adverse Reactions: Postoperative inflammatory reactions as well as incidents of corneal edema and corneal decompensation have been reported. Their relationship to the use of BSS PLUS® Irrigating Solution has not been established.

Overdosage: The solution has no pharmacological action and thus no potential for overdosage. However, as with any intraocular surgical procedure, the duration of intraocular manipulation should be kept to a minimum.