Ophthalmic viscosurgical devices (OVDs) consisting of chondroitin sulfate-hyaluronic acid may lead to better outcomes for the corneal endothelium after cataract surgery compared with other OVDs, according to a study published in Clinical Ophthalmology. The research also found that corneal thickness (CT) increase is significantly lower with chondroitin sulfate-hyaluronic acid OVDs than hyaluronic acid-only OVDs.
Researchers searched MEDLINE and EMBASE databases from 2000 to 2020 for randomized controlled trials (RCTs, N ≥ 20 per group) comparing an OVD containing chondroitin sulfate-hyaluronic acid (ie, VISCOAT®, DuoVisc® or DisCoVisc®) with any other OVD.
The OVDs found in the literature included those composed of hyaluronic acid-only or hydroxypropyl methylcellulose. Outcomes of interest included changes in endothelial cell density (baseline to 3 months) and CT (baseline to 24 hours).
The research team screened a total of 966 abstracts and extracted data from 12 RCTs.
Chondroitin sulfate-hyaluronic acid OVDs had significantly lower endothelial cell loss compared with hyaluronic acid-only OVDs, (MD: −4.10%; 95% CI: −5.81 to −2.40; P < .0001; 9 studies). Chondroitin sulfate-hyaluronic acid OVDs also had significantly lower endothelial cell loss compared with hydroxypropyl methylcellulose OVDs, (MD: −6.47%; 95% CI: −10.41 to −2.52; P =.001; 2 studies).
Chondroitin sulfate-hyaluronic acid OVDs had statistically significantly less CT increase compared with hyaluronic acid-only OVDs, (MD: −3.22%; 95% CI: −6.24% to −0.20%; P =.04; 4 studies). However, there were no significant differences in CT change between chondroitin sulfate-hyaluronic acid OVDs and hydroxypropyl methylcellulose OVDs, (MD: 2.65%; 95% CI: −0.43% to 0.95%; P =.4; 2 studies).
“In summary, chondroitin sulfate-hyaluronic acid OVDs provide effective corneal protection and minimize the loss of valuable corneal endothelial cells following cataract surgery, relative to other OVDs,” according to the researchers. “The selection of the most suitable OVD is crucial for optimal postoperative outcomes in patients, especially in complex cases, where chondroitin sulfate-hyaluronic acid OVDs should be strongly considered.”
Study limitations include the differences and inconsistency in reporting of outcomes for the studies, and there were limited data on hydroxypropyl methylcellulose.
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. This research was supported by Alcon Vision, LLC. Please see the original reference for a full list of disclosures.
Hsiao CW, Cheng H, Ghafouri R, Ferko NC, Ayres BD. Corneal outcomes following cataract surgery using ophthalmic viscosurgical devices composed of chondroitin sulfate-hyaluronic acid: a systematic review and meta-analysis. Clin Ophthalmol. Published online July 24, 2023. doi:10.2147/OPTH.S419863