Ophthalmic Viscosurgical Devices Composed Of Chondroitin Sulfate-Hyaluronic Acid For Corneal Endothelial Protection During Cataract Surgery: A Literature Review And Meta-Analysis

Ophthalmic viscosurgical devices (OVDs) are well-established for use during cataract surgery to minimize the risk of damage to intraocular tissue and create space in the anterior chamber of the eye. OVDs help to protect the corneal endothelium during cataract surgery by reducing surgical trauma. Several OVDs are available with different constituents; one of these is chondroitin sulfate, a proven natural and safe compound. Systematic literature review and meta-analysis were conducted to assess the clinical evidence of OVDs composed of chondroitin sulfate-hyaluronic acid (CS-HA) versus other OVDs in minimizing endothelial cell loss (ECL) and corneal thickness (CT) increase.

Not applicable.

The literature was searched systematically in MEDLINE and EMBASE databases, from 2000 to 2020. Randomized controlled trials (RCTs, N ≥ 20 per group) comparing an OVD containing CS-HA (ie, VISCOAT®, DuoVisc® or DisCoVisc®) to any other OVD were included. Non-comparative studies and pre-clinical evidence were excluded. Identified comparators consisted of OVDs composed of HA-only or hydroxypropyl methylcellulose (HPMC). Outcomes of focus included ECL from baseline to 3 months and changes in CT from baseline to 24 hours (12 studies included, 5 studies reported both ECL and CT). Meta-analyses were performed using R software, to assess mean differences (MD) in ECL and CT change between CS-HA OVDs and HA-only or HPMC OVDs.

A total of 966 abstracts were screened and data were extracted from 12 RCTs. Meta-analyses using a random-effects model revealed significantly lower percent (%) ECL for CS-HA OVDs compared to both HA-only (MD: -4.10%; 95% CI: -5.81 to -2.40; p < 0.0001; 9 studies) and HPMC (MD: -6.47%; 95% CI: -10.41 to -2.52; p = 0.001; 2 studies) products. Similarly, % CT change was significantly lower with CS-HA than with HA-only OVDs (MD: -3.22%; 95% CI: -6.24% to -0.20%; p = 0.04; 4 studies). There were no significant differences when comparing % CCT change between CS-HA and HPMC OVDs (MD: 2.65%; 95% CI: -0.43% to 0.95%; p = 0.4; 2 studies).

OVDs composed of CS-HA appear to better protect the corneal endothelium by reducing postoperative endothelial cell loss, relative to other OVDs. This may be attributed to their unique composition and benefits of chondroitin sulfate. The selection of the most suitable OVD is crucial for optimal postoperative outcomes in patients and CS-HA OVDs should be strongly considered.