VISCOELASTIC

POLYMERS

BY :- -: GUIDED BY :-
Varsha Jagdale 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

2) EFFECTIVE IN SEALING CAPSULAR TEAR AND KEEPING THE

IRIS

DISADVANTAGES:

1) THEY DO NOT MAINTAIN SPACE WELL AND INCREASE RISK OF

BURN IN PHACOEMULSIFICATION
 PROPERTIES OF
•
VISCOELASTICS
COHESION OR DISPERSION

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 Advanced Medical Optics, Inc. (AMO)

Item Healon
Polymer Composition 1% sodium hyalouranale
Volume 0.4 mL, 0.55 mL, and 0.85 mL
Features •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
Resting State Viscosity 300,000 mpas
Molecular Weight 4 million Daltons
• HEALON GV

HEALON GV

GENERAL INFORMATION
Vendor Advanced Medical Optics, Inc. (AMO)

Item Healon GV
Polymer Composition
1.4% sodium hyaluronate Composition
Volume 0.85 mLand 0.55 mL

Features •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.

Resting State Viscosity 3 million mPas

Molecular Weight 5 million Daltons

 CELLUGEL

CELLUGEL®

GENERAL INFORMATION
Vendor Alcon Laboratories

Item CelluGel®

Polymer Composition 2% hydroxypropyl methylcellulose

Volume 1.0 mL

Features •1.0 mL fill size

•Single-use cannula provided
•No refrigeration required
Resting State Viscosity 30,000 ± 10,000 mPas

Molecular Weight 300,000 Daltons

 VISCOAT

VISCOAT®

General Information
Vendor Alcon Laboratories

Item VisCoat®

Polymer Composition 3% sodium hyaluronate, 4% chondroitin sulfate

Volume 0.50 ml

Features •a highly retentive, dispersive viscoelastic

characterized by low molecular weight, low
pseudoplasticity and low surface tension
•provides good space maintenance and
excellent tissue protection.

Resting State Viscosity 40,000 ± 20,000 cps (at shear rate of 2 sec-1,
25° C)

Molecular Weight medium molecular weight sodium chondroitin

sulfate
AMVISC

AMVISC®

General Information

Vendor Bausch & Lomb

Item Amvisc®

Polymer Composition 1% sodium hyaluronate Composition

Volume 0.5 ml or 0.8 ml

Features •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

Resting State Viscosity 100,000-300,000 centipoise

Molecular Weight 1.1-1.8 x106

6.OCUCOAT
General Information
Vendor Bausch & Lomb
Item Ocucoat
Polymer Composition 2% Hydroxypropyl Methylcellulose
Features •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.
Resting State Viscosity 2 million mPas

Molecular Weight low molecular weight of Ocucoat viscoelastic

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