Use of viscoelastic solutions in ophthalmology: a review of physical properties and long-term effects

Solutions of flexible macromolecules are used in ophthalmic surgery for insertion of intraocular lens, during corneal transplantation, in cataract, corneal, glaucoma, trauma, and vitreo-retinal surgery. Polymeric materials used in formulating these solutions include hyaluronic acid, chondroitin sulfate, polyacrylamide, collagen, and mixtures of some of these materials. Although the physical properties of these materials have been studied extensively, the long-term effects resulting from transitory increases in intraocular pressure and loss of even a small number of corneal endothelial cells are still unknown. The purpose of this paper is to review the literature that is available on these topics.