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Cataract Extraction and Corneal Endothelial Protection

Certain clinical situations place undue stress on the corneal endothelium, retina, and other ocular structures. BSS PLUS® Irrigating Solution combines an energy source, a buffer, and an antioxidant to maximally protect and nourish the health of intraocular tissues.

The positive outcomes experienced in routine cataract surgery are the result of many improvements occurring over the last 30 years. Advanced phacoemulsification techniques and equipment, advanced intraocular lenses, advanced ophthalmic viscosurgical devices, and advanced drugs and solutions have all played important roles. BSS PLUS® Irrigating Solution has a key role in corneal endothelial protection during routine cataract procedures.

After intraocular surgery, corneal endothelial cellular morphologic changes are noted that are indicative of a stressed endothelial monolayer, which may be more susceptible to additional surgical trauma.

After 15 minutes of irrigation with BSS PLUS® Irrigating Solution, cellular-density was unchanged from preoperative values compared with balanced salt solution. BSS PLUS® Irrigating Solution was associated with less corneal swelling and a significantly higher percentage of hexagonal cells at two and seven days after surgery.1

Conclusion: BSS PLUS® Irrigating Solution protects the corneal endothelium by minimizing polymegathism and pleomorphism during short and long term irrigation of the anterior chamber, whereas balanced salt solution does not.1

Cataract extraction
Corneal Thickness and Endothelial Hexagons Days Post Op

Corneal and Retinal Edema See More

The glutathione in BSS PLUS® Irrigating Solution is taken up by corneal endothelial cells2 and helps protect them from free radicals produced by the surgical incision, the microscope light and the phacoemulsification probe. Additionally, BSS PLUS® Irrigating Solution provides intraocular tissues with dextrose bicarbonate for an energy source and bicarbonate a natural buffer. Together they promote normal corneal thickness and enhance the endothelial pump function.

Surgically-induced corneal or retinal edema may be caused by:

  • Low corneal endothelial cell counts
  • Mechanical trauma from instruments used in phacoemulsification and vitrectomy
  • Toxic effect on the tissues from:
    • drugs
    • light sources
    • solutions
    • oxygen-free radicals
    • preservatives
Corneal and Retinal Edema

Working with Viscoelastics See More

A study from Emory University explored the permeability of the viscoelastic layer and measured the flux of dextrose, a constituent of BSS PLUS® Irrigating Solution, across a layer of viscoelastic material over time.

Conclusion: ProVisc® and VISCOAT® Ophthalmic Viscosurgical Devices readily permit the diffusion of dextrose3; therefore, BSS PLUS® Irrigating Solution can continue to provide physiologic support to the corneal endothelium, even when viscoelastics are used.

Used in conjunction with viscoelastics, BSS PLUS® Irrigating Solution provides nourishment, promotes a safe environment, and helps restore health to ocular tissues. In fact, BSS PLUS® Irrigating Solution helps you successfully deal with routine surgical cases as well as difficult ones.

DuoVisc® Viscoelastic System
 
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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.

Important information about DuoVisc® OVD

Description: DuoVisc® Viscoelastic System is designed to give two Viscoelastic materials with different physico-chemical properties that can be used differently and/or sequentially to perform specific tasks during a cataract procedure. DuoVisc® Viscoelastic System consists of VISCOAT® Ophthalmic Viscosurgical Device and ProVisc® Ophthalmic Viscosurgical Device.

Caution: Federal (USA) law restricts this device to sale by, or on the order of, a physician.

Description: VISCOAT® (Sodium Chondroitin Sulfate – Sodium Hyaluronate) Ophthalmic Viscosurgical Device

Indications: VISCOAT® OVD is indicated for use as an ophthalmic surgical aid in anterior segment procedures including cataract extraction and intraocular lens (IOL) implantation. VISCOAT® OVD maintains a deep anterior chamber during anterior segment surgeries, enhances visualization during the surgical procedure, and protects the corneal endothelium and other ocular tissues. The viscoelasticity of the solution maintains the normal position of the vitreous face and prevents formation of a flat chamber during surgery.

Warnings: Failure to follow assembly instructions or use of an alternate cannula may result in cannula detachment and potential patient injury.

Precautions: Precautions are limited to those normally associated with the surgical procedure being performed. Although sodium hyaluronate and sodium chondroitin sulfate are highly purified biological polymers, the physician should be aware of the potential allergic risks inherent in the use of any biological material.

Adverse Reactions: VISCOAT® OVD has been extremely well tolerated in human and animal studies. A transient rise in intraocular pressure in the early postoperative period may be expected due to the presence of sodium hyaluronate, which has been shown to effect such a rise. It is therefore recommended that VISCOAT® OVD be removed from the anterior chamber by thorough irrigation and/or aspiration at the end of surgery to minimize postoperative IOP increases. Do not overfill anterior chamber.

ATTENTION: Reference the Physician Labeling/Directions for Use for a complete listing of indications, warnings and precautions.