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Free Radicals in Phacoemulsification and Aspiration Procedures
Hiroshi Takahashi, MD;
Atsuhiro Sakamoto, MD;
Ryoki Takahashi, PhD;
Takeo Ohmura, PhD;
Shigeto Shimmura, MD;
Kunitoshi Ohara, MD
Arch Ophthalmol. 2002;120:1348-1352.
Objectives To detect free radicals in phacoemulsification and aspiration procedures
using electron-spin resonance and to observe the effect of ophthalmic viscosurgical
devices (viscoelastic agents) on free radical intensity.
Methods (1) A test tube containing BSS Plus (Alcon Laboratories, Inc, Fort Worth,
Tex) with 1% of the spin-trapping agent, 5,5'-dimethyl-1-pyrroline N-oxide, without irrigation and aspiration, was exposed
to ultrasound (100% for 20 seconds). A preparation of hyaluronate sodium (Healon
[a cohesive agent that contains 1% hyaluronate sodium] {Pharmacia, Uppsala,
Sweden} or Viscoat [a dispersive agent that contains 3% hyaluronate sodium
and 4% chondroitin sulfate] {Alcon Laboratories, Inc}) was added to the solution
to observe inhibitory effects. (2) To simulate a clinical procedure, an eye
model with irrigation and aspiration of a combination of 1% 5,5'-dimethyl-1-pyrroline N-oxide and BSS Plus, 25 mL/min, as the irrigating solution
was exposed to ultrasound (for 10, 20, or 30 seconds). Healon or Viscoat was
injected into the anterior chamber. Free radicals were measured by an electron-spin
resonance spectrometer.
Results (1) A characteristic signal corresponding to hydroxyl radicals was detected.
Similar inhibition by Healon and Viscoat was observed. (2) Two ophthalmic
viscosurgical devices similarly suppressed the signal at 10 seconds. The inhibition
by Healon ceased at 20 seconds, whereas Viscoat suppressed the signal throughout
the time course.
Conclusions Phacoemulsification produces hydroxyl radicals in the anterior chamber
even with irrigation and aspiration. The effect of ophthalmic viscosurgical
devices on free radicals depends on the retention of the materials within
the anterior chamber.
Clinical Relevance There are complications associated with phacoemulsification.
From the Departments of Ophthalmology (Drs H. Takahashi and Ohara)
and Anesthesiology (Dr Sakamoto), Nippon Medical School, Tokyo; Sagami Laboratory,
Wakamoto Pharmaceutical Co, Ltd, Kanagawa (Drs R. Takahashi and Ohmura); and
the Department of Ophthalmology, Tokyo Dental College, Chiba (Dr Shimmura),
Japan. None of the authors has any commercial or proprietary interest in the
products or companies described in this article.
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