Comparison of BD Multivisc™ with the soft shell technique in cases with hard lens nucleus and Fuchs endothelial dystrophy

PURPOSE. To compare the efficacy of 2.5% sodium hyaluronate (BD Multivisc™) with the soft shell technique in reducing corneal endothelial cell damage during cataract phacoemulsification in patients with hard lens nucleus (3+) and cornea guttata. METHODS. Thirty patients (37 eyes) scheduled for cataract surgery at Department of Ophthalmology and Visual Sciences, University Hospital San Raffaele, Milano, Italy. Thirty-seven eyes (randomly divided into Groups A and B) with hard lens nucleus (grade 3 or higher) and cornea guttata had phacoemulsification using the soft shell technique (Group A) with Biolon® (sodium hyaluronate 1%) and Viscoat® (sodium hyaluronate 3%-chondroitin sulfate 4%) or with BD Multivisc™ alone (Group B). Patients were evaluated preoperatively and after 1, 15, 90, and 180 days, checked for best-corrected visual acuity (BCVA), intraocular pressure (IOP), central corneal thickness, and corneal endothelial density. Stop and chop phacoemulsification technique, with burst mode (Alcon Legacy 20000, Advantec), was performed. RESULTS. There were no significant differences between the two groups at 3 and 6 months in BC-VA, IOP, corneal thickness, or endothelial cell density. The increase of central corneal thickness (preoperative: Group A 584±30 μm, Group B 573±30 μm; postoperative at 90 days: Group A 593±38 μm, Group B 577±25 μm) was not significant. Endothelial cell loss was similar in both groups. CONCLUSIONS. The results suggest that the soft shell technique (Biolon®, Viscoat®) and 2.5% sodium hyaluronate (BD Multivisc™) are both effective in protecting the corneal endothelium in Fuchs dystrophy during phacoemulsification in patients with hard lens nucleus.