VISCOELASTIC POLYMERS

BY :Varsha Jagdale

-: GUIDED BY :Mrs. Sapna Paul

DEFINITION

VISCOELASTIC NEED
The endothelium gets damaged due to:

• CONTACT WITH AN ARTIFICIAL LENS. • BENDING OF CORNEA. • EXTENSIVE RUBBING OF THE ENDOTHELIUM WITH NATURAL LENS AND THROUGH CONTACT WITH INSTRUMENTS. • ULTRASONIC ENERGY BURN BY A PHACOEMULSIFICATION OF NUCLEUS.

FUNCTIONS OF VISCOELASTICS
• STABILIZATION OF THE ANTERIOR CHAMBER. • PROTECTIVE EFFECT BY ADHERING ENDOTHELIUM, COATING IT DURING THE PROCEDURE. • AS A VITREOUS SUBSTITUTE IN CASE OF VITREOUS LOSS AND RETINAL DETACHMENT SURGERY.

CORNEAL PROTECTION
• CAUSES : 1) MECHANICAL IRRITATION 2) BOMBARDNING OF LENS FRAGMENTS • DISPERSIVE SUBSTANCES:

VISCOELASTIC CAN BE USED IN FOUR WAYS

VISCOELASTICS USED IN EYES
• • • • • INERT AND ISO-OSMOTIC. OPTICALLY CLEAR. VISCOUS HYDROPHILIC AND DILUTABLE PROTECT THE CELLS, SEPARATE THE TISSUE AND MAINTAINS SPACE AND ACT AS A LUBRICANT.

HYDROXY PROPYL METHYLCELLULOSE

HYDROXY PROPYL METHYLCELLULOSE
• THE BASIC MOLECULE IS d-GLUCOSE • TWO MOLECULES OF GLUCOSE COMBINE TO FORM CELLOBOISE WHICH DIFFERS FROM MALTOSE ONLY BY THE WAY THE TWO MOLECULES ARE STEREO CHEMICALLY ARRANGED. • IN CELLOBOISE THE BONDING IS BETAGLYCOSIDIC IN MALTOSE IT IS ALPHA GLYCOSIDIC

SODIUM HYALURONATE

For lens implantation, sodium hyaluronate may be used in four ways

CHONDROITIN SULFATE

PROBLEMS RELATED WITH VISCOELASTICS
ONE MAJOR DRAWBACK OF VISCOELASTICS IS RETENATION OF THE SUBSTANCE AFTER SURGERY RESULTING IN INCREASED POSTOP INTRAOCULAR PRESSURE(IOP) IN SOME PATIENTS. WHEN THESE IOP’s ARE HIGH (i.e. SPIKES, DEFINED AS >30mmHg), OR THE PATIENT HAS GLAUCOMATOUS DISCS THIS BECOMES AN IMPORTANT ISSUE.

RHEOLOGY
• THE FLOW OF NEWTONIAN FLUID IS EXPRESSED BY USING EQUATION ŋ=F/G F= Shear Stress G= Shear rate • ELASTICITY BEHAVIOUR IS EXPRESSED BY EXPRESSION FOR A SPRING E=F/γ E= Modulus of elasticity dyne/cm²) γ= The strain (dimensionless) F= The stress (dyne/cm²)

b) Spring

a) Dashpot

) Dashpot & Spring in series (Maxwell unit)

TYPES OF VISCOELASTICS
COHESIVES : ADVANTAGES : 1) BEST FOR MAINTAINING ANTERIOR CHAMBER, AND CREATING SPACE 2) EASY TO REMOVE BECAUSE OF HIGH SURFACE TENSION DISADVANTAGES: 1) CAN BE LOST IN LARGE AMOUNT THROUGH WOUND DURING CAPSULORRHEXIS IF THE WOUND IS OPEN 2) TEND TO GO AWAY WITH THE FIRST VACCUM AND DO NOT PROTECT THE ENDOTHELIUM WELL

15.

DISPERSIVES: ADVANTAGES: 1) BEST FOR PROTECTING THE CORNEAL ENDOTHELIUM IRIS 2) EFFECTIVE IN SEALING CAPSULAR TEAR AND KEEPING THE

DISADVANTAGES: 1) THEY DO NOT MAINTAIN SPACE WELL AND INCREASE RISK OF BURN IN PHACOEMULSIFICATION

COHESION OR DISPERSION

PROPERTIES OF VISCOELASTICS

FUNCTION OF BOTH ELASTICITY AND MOLECULAR LENGTH • ELASTICITY

POSITIVELY CORRELATED WITH ITS MOLECULAR WEIGHT AND ZERO SHARE VISCOSITY

MOLECULAR CHARGE THE COATING ABILITY OF A VISCOELASTIC IS DETERMINED IN PART BY ITS MOLECULAR CHARGE

MOLECULAR WEIGHT DETERMINES ITS ENTIRE SPECTRUM OF PHYSICAL ATTRIBUTES

• • • •

PHYSIOCHEMICAL PROPERTIES PSEUDOPLASTICITY SURFACE TENSION VISCOSITY VISCOSITY AFFECTS THE VISCOELASTICS ABILITY TO MAINTAIN SPACE, TO SERVE AS A SOFT INSTRUMENTS FOR MANIPULATING TISSUE AND TO PROTECT THE CORNEAL ENDOTHELIUM.

PRODUCTS
• HEALON
HEALON GENERAL INFORMATION
Vendor Item Polymer Composition Volume Features Advanced Medical Optics, Inc. (AMO) Healon 1% sodium hyalouranale 0.4 mL, 0.55 mL, and 0.85 mL •It has a high molecular weight. •It is reported to be nonantigenic. • It does not cause inflammatory or foreign body reactions. •It has a high viscosity •Sterile, single-use 27G cannula included with each syringe. •The 1% solution of Healon is transparent is reported to remain in the anterior chamber for less than 6 days. •Protects corneal endothelial cells and other ocular structures 300,000 mpas 4 million Daltons

Resting State Viscosity Molecular Weight

HEALON GV
HEALON GV GENERAL INFORMATION

Vendor Item Polymer Composition Volume Features

Advanced Medical Optics, Inc. (AMO) Healon GV 1.4% sodium hyaluronate Composition 0.85 mLand 0.55 mL •Healon GV creates and maintains a deep anterior chamber, to facilitate manipulation inside the eye with reduced trauma to the corneal endothelium and other ocular tissues. •Expands the anterior chamber and flattens the anterior capsule to facilitate capsulorrhexis •Possesses the highest moleculare weight of any ophthalmic viscosurgical device •Absorbs forces associated with IOL implantation •Sterile, single-use 27G cannula included with each syringe •Healon GV also can be used to efficiently maneuver, separate and control ocular tissues. 3 million mPas 5 million Daltons

Resting State Viscosity Molecular Weight

CELLUGEL
CELLUGEL® GENERAL INFORMATION
Vendor Item Polymer Composition Volume Features Alcon Laboratories CelluGel® 2% hydroxypropyl methylcellulose 1.0 mL •1.0 mL fill size •Single-use cannula provided •No refrigeration required 30,000 ± 10,000 mPas 300,000 Daltons

Resting State Viscosity Molecular Weight

VISCOAT
VISCOAT® General Information
Vendor Item Polymer Composition Volume Features Alcon Laboratories VisCoat® 3% sodium hyaluronate, 4% chondroitin sulfate 0.50 ml •a highly retentive, dispersive viscoelastic characterized by low molecular weight, low pseudoplasticity and low surface tension •provides good space maintenance and excellent tissue protection. 40,000 ± 20,000 cps (at shear rate of 2 sec-1, 25° C) medium molecular weight sodium chondroitin sulfate

Resting State Viscosity Molecular Weight

AMVISC AMVISC®

General Information

Vendor Item Polymer Composition Volume Features

Bausch & Lomb Amvisc® 1% sodium hyaluronate Composition 0.5 ml or 0.8 ml •the right viscoelastic agent for the planned extracap technique •possesses sufficient viscosity for excellent chamber maintenance during lens removal. •highly cohesive so that complete removal at the end of the case is easily and quickly accomplished priced to compete with any sodium hyaluronate viscoelastic agents 100,000-300,000 centipoise 1.1-1.8 x106

Resting State Viscosity Molecular Weight

6.OCUCOAT General Information
Vendor Item Polymer Composition Features Bausch & Lomb Ocucoat 2% Hydroxypropyl Methylcellulose •2% Hydroxypropyl Methylcellulose solution •Especially well suited for high volume, small incision surgery •The low molecular weight of Ocucoat viscoelastic allows for rapid removal with minimal risk of elevated intraocular pressure •The clarity of Ocucoat permits an unobstructed view of the surgical field throughout capsulorhexis and phacoemusification Ocucoat is the least expensive viscoelastic alternative available and Ocucoat is the most lubricious viscoelastic agent on the market. 2 million mPas low molecular weight of Ocucoat viscoelastic

Resting State Viscosity Molecular Weight

HOW CATARACT SURGERY IS DONE
• Intra-Capsular Cataract Extraction

• Viscoelastic in Anterior Chamber

IRIS

ACIOL

PCIOL

Foldable PCIOL

Unfolded Lens in Capsular Bag

Extra-Capsular Cataract Extraction

Kelman PhacoEmulsification (KPE)

Ultrasonic Removal Of Cataract

Major complications may include:

• - Endophthalmitis (severe infection inside the eye) • - Suprachoroidal Hemorrhage (severe bleeding inside the eye) • - Bullous Keratopathy (swelling of the cornea that cannot be reversed) • - Retinal Detachment
• Minor Complications may include:

• • • • • • •

-An irregular pupil shape - Iritis, inflammation or swelling Inside the eye - Off-centre lens placement - Retinal tear or retinal hole - Glaucoma, raised internal eye pressure - Macular Edema, swelling of the central retina - Secondary Cataract

THANK YOU

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