• Comprehensive Ophthalmology

    Dextrose bicarbonate Lactated Ringer's solution for irrigation has been reported to be as effective as enriched BSS during cataract surgery. However, Lactated Ringer's is 30 times cheaper than BSS Plus. Given the need to optimize cataract surgery costs, especially in poorer countries, the authors designed this prospective  masked study to compare differences in preservation of corneal integrity after phacoemulsification cataract surgery using these two intraocular irrigating solutions.

    Subjects inlcuded 110 patients undergoing uncomplicated phacoemulsification randomized to BSS or Ringer's solution. They were examined at baseline and at one, eight, 15, 30 and 60 days postoperatively.

    There was no statistically significant difference between the groups in terms ofreduction of endothelial cell density, in cell size variability or in central corneal thickness  at day 60 or at any study visit. However, in the Ringer's group, there was a trend toward lower postoperative endothelial cell density for surgeries with longer phacoemulsification time and higher irrigation volumes.

    They conclude that Ringer's solution is associated with a corneal endothelial cell reduction similar to BSS Plus, if the surgeon uses limited phacoemulsification time and irrigation volume. However, for cataract operations that may require a higher volume of irrigation solution or longer phacoemulsification time, such as dislocated lens, dense cataracts and inexperienced surgeons cases, BSS Plus may contribute to lower endothelial cell loss.