It will be difficult to find an ophthalmic surgeon who will gladly do his work entirely without viscoelastics. Within just a few years this group of substances has enlarged the field of ophthalmic surgery enormously. Many procedures have be come safer and simpler and other techniques could only be developed because of the availability of visco elastics. Especially cataract surgery and implantation of intraocular lenses have benefitted. Implantation of an intraocular lens can be per formed much more reliably into the capsular bag without endangering the posterior capsule. Implantation of foldable lenses would be almost impossible without visco elastics. However, other surgical maneuvers also necessitate visco elastics, especially when the anterior chamber must be maintained, the corneal endothelium must be protected and delicate tissues must be manipulated. A cor neal transplant can be sutured safely into the recipient corneal ring using visco elastics. Even in glaucoma surgery, visco elastics gain importance as they are being used in trabeculectomy or in deep sclerectomy with additional viscocana lostomy. But which substance is best for which purpose? Just as much as a basic phar macological knowledge is necessary for a rational use of drugs, in-depth know ledge of physicochemical properties and objective investigations are prerequi sites for a logical selection of visco elastics from an ever increasing number of available substances. H.

1 Overview

Historical Development
Current Breakdown of Viscoelastic Substances
Analysis of Current Application Modes
2 Basics
Physicochemical Properties of Ophthalmic Viscosurgical Devices
Optical Properties of Viscoelastic Substances
Chemical Properties of Viscoelastic Substances, Biocompatibility and Safety Requirements
3 Viscoelastic Substances
Hyaluronate
Hydroxypropylmethylcellulose
Chondroitin Sulfate
Polyacrylamide
Collagen
Cellugel®
4 Product Specifications
Manufacturers' Information About Their Viscoelastics
Our Own Comparative Trials
5 General Applications of Viscoelastics
Maintenance of the Anterior Chamber
Tissue Manipulations
Coatability
Corneal Endothelial Protection
Hemostasis
Management of Complications
6 Complications Through the Use of Viscoelastics
Therapy for Raised IOP Following Phacoemulsification
7 Special Uses of Viscoelastics
Cataract Surgery
Implantation of Foldable IOLs
Perforating and Lamellar Keratoplasty
Glaucoma Surgery
Trauma Surgery
Posterior Segment Surgery
Surgery of Eye Muscles
Lacrimal Dysfunction (Coating Medium)
8 Removal of ViscoelasticSubstances
The "Rock and Roll" Technique
Retention of the Viscoelastic Substance
9 Healon®5: A New Viscoadaptive Formulation
10 Aseptic Production vs. Terminal Sterilization
11 Viscoelastics: Medical Device or Drug
12 Summary
Product Overview
- Hyaluronic Acid Products
- HPMC-Products
Measured Values for Certain Products Gained by Individual Investigations
- Viscoelastics Containing Hyaluronic Acid
- Viscoelastics from Hydroxypropylmethylcellulose
References.