OPHTHALMOLOGY CORNEAL RESULTS OF 5 DIFFERENT OVD´S IN PHACO

1. Prospective Nonrandomized Comparison of Different OVD´s in Non-eventful Phacoemulsification ASCRS, 2008 Fernando Aguilera MD NO FINANCIAL INTEREST

3. Ovd’s clasification Low Viscosity Dispersive Viscoadaptives and Superviscous Cohesives Viscous Cohesive Dis Co Visc ™ Viscoat ® Cellugel ® Ocucoat ® Healon ® -GV Healon ® -5 Healon ® Provisc ® Amvisc ® Visco Dispersive

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7. Transoperative OVD behavior evaluation: 1- Ease of injection 2- Visibility 3- Pupil manipulation 4- AC maintainance (ccc, Phaco) 5- IOL implantation 6- I/A post IOL

8. Results : subjective Mean Surgical Difficulty by OVD 0 1 2 3 Cataract Extraction IOL Insertion Overall Difficulty Level DisCoVisc DuoVisc BioVisc Healon5 AmviscPlus

9. Mean Ease of Injection and Visualization Post Injection 1=Poor 2=Fair 3=Good 4=Excellent 0 1 2 3 4 DisCoVisc DuoVisc BioVisc Healon5 AmviscPlus Level of Ease Injection Visualization

10. Anterior Chamber Maintenance During Surgical Phases 0 1 2 3 4 5 Anterior Capsulotomy Phacoemulsification IOL Insertion Maintenance Scale DisCoVisc DuoVisc BioVisc Healon5 AmviscPlus

11. Mean Ocular Inflammation 1 Day Postoperatively 0 1 2 3 Edema Cell Flare Inflammation Level DisCoVisc DuoVisc BioVisc Healon5 AmviscPlus

12. Results objective

13. Mean Endothelial Cell Count Pre- and Post-Operatively 0 500 1000 1500 2000 PreOp 1 Month Post 2 Months Post cells/mm2 DisCoVisc DuoVisc BioVisc Healon5 AmviscPlus

14. Mean Pachymetry Pre- and Post-operatively 500 520 540 560 PreOp 1 Month Post 2 Months Post um DisCoVisc DuoVisc BioVisc Healon5 AmviscPlus

15. p = 0.0290 Note: A statistically significant difference (p = 0.0290 ) was found for % ECC loss by CDE level.

16. 2 Month Postop: % ECC Loss by CDE Level -10 0 10 20 30 40 50 60 <5.0 >5 to <10 >10 to <15 >15 to <20 >20 CDE Range ECC Loss DisCoVisc DuoVisc BioVisc Healon5 AmviscPlus

17. 2 Month Postoperative: ECC Loss by BSS Volume -10 0 10 20 30 40 50 60 70 ? 100 101-200 201-300 BSS Volume (mL) cells/mm2 DisCoVisc DuoVisc BioVisc Healon5 AmviscPlus

18. ECC Loss by CDE and BSS Levels 0 10 20 30 40 50 <5.0 >5 to <10 >10 to <15 >15 to <20 >20 CDE cells/mm2 ? 100 101-200 201-300

19. 2 Months Postoperatively: Percent ECC Loss by Preoperative ECC -10 0 10 20 30 40 ECC <1500 Preop ECC >1500 Preop Percent Loss All OVDs DisCoVisc DuoVisc BioVisc Healon5 AmviscPlus

20. Note: * indicates OVD with statistically significantly less ECC loss per Tukey’s studentized range test . % ECC Loss Preop to 2 Months Postop: Statistically Significant Pairs p < 0.05 p < 0.05 p < 0.05 DisCoVisc* p < 0.05 p < 0.05 p < 0.05 DuoVisc* p < 0.05 AmviscPlus BioVisc AmviscPlus* Healon5

24. Mean Number of OVD Vials Utilized per Case 0 0.5 1 1.5 2 2.5 DisCoVisc DuoVisc BioVisc Healon5 AmviscPlus Vial Number

25. Mean Infiniti CDE Reading by OVD 0 2 4 6 8 10 DisCoVisc DuoVisc BioVisc Healon5 AmviscPlus CDE

26. Mean Grade of Cataract by OVD 1=Soft 2=Medium 3=Hard 4= Brittle 0 1 2 3 4 DisCoVisc DuoVisc BioVisc Healon5 AmviscPlus Grade

27. Mean Estimated Percent of OVD Retention 0 3 6 9 12 15 DisCoVisc DuoVisc BioVisc Healon5 AmviscPlus Percent

28. Mean Capsural Bag Maintenance During Surgery 1=Poor 2=Fair 3=Good 4=Excellent 0 1 2 3 4 DisCoVisc DuoVisc BioVisc Healon5 AmviscPlus Maintenance Scale

29. Mean Difficulty of OVD Aspiration 1=Very Easy 2=Easy 3=Neither Easy or Difficult 4=Difficult 5=Very Difficult 0 1 2 3 4 5 DisCoVisc DuoVisc BioVisc Healon5 AmviscPlus Difficulty Level

30. Mean Effectiveness of Pupil Expansion 1=Not Effective 2=Moderately Effective 3=Very Effective 0 1 2 3 DisCoVisc DuoVisc BioVisc Healon5 AmviscPlus Effectiveness Level

31. Mean Intraocular Pressure 1 Day Postoperatively 0 5 10 15 20 DisCoVisc DuoVisc BioVisc Healon5 AmviscPlus mmHg

32. Percent ECC Loss by Cataract Grade: Preop to 2 Month Postop -10 0 10 20 30 40 1 2 3 4 Cataract Grade Percent DisCoVisc DuoVisc BioVisc Healon5 Amvisc Plus

33. Note: No statistical difference exists (p = 0.5489) in % ECC loss by cataract grade. (p = 0.5489)

34. 2 Months Postop: % ECC Loss by CDE Level (All OVDs) 0 10 20 30 40 50 <5.0 >5 to <10 >10 to <15 >15 to <20 >20 CDE Range % ECC Loss

36. MCTo ECC: 8% < ToSt / 16% < Trphaco MCTo Pach: >< ToSt / 16% < Trphaco 9.6% 8.9% 8.1% 5.2% 4.0% 4.1% 0.0% 2.0% 4.0% 6.0% 8.0% 10.0% LONGITUD. (106 Surgeries) TORSIONAL (102 Surgeries) TORS'L+ULTRA (102 Surgeries) Patient Outcome Parameter Comparison Pachymetry (% increase in thickness) Endothelium Cell Loss (% cell loss)