The patients preoperatively underwent 2 peripheral iridotomies with a neodymium-YAG laser. On the day of surgery, the patients were given dilating and cycloplegic agents. After topical anesthesia, a model V4b ICL (without a central hole) was inserted through a 3-mm clear corneal incision with the use of an injector cartridge (STAAR Surgical) after placement of a viscosurgical device (OpeganTM; Santen, Osaka, Japan) into the anterior chamber. The ICL was placed in the posterior chamber, the remaining viscosurgical device was completely washed out from the anterior chamber with balanced salt solution, and a miotic agent was instilled. For toric ICL implantation, to control for potential cyclotorsion in a supine position, the zero horizontal axis was marked preoperatively using a slit-lamp. After the ICL had then been placed in the posterior chamber and rotated by 22.5 degrees or less using the manipulator. Postoperatively, steroidal (0.1% betamethasone, RinderonTM, Shionogi, Osaka, Japan) and antibiotic (0.3% levofloxacin, CravitTM, Santen, Osaka, Japan) medications were administered topically 4 times daily for 2 weeks, and the dose was steadily reduced thereafter.
Opegan
Manufactured by Santen
Sourced in Japan
Opegan is a sterile, viscoelastic ophthalmic surgical product. It is designed for use during ophthalmic procedures to maintain the anterior chamber and to facilitate intraocular lens implantation.
Automatically generated - may contain errors
Lab products found in correlation
Cravit, by Santen (3 mentions)
Wavelight fs200, by Alcon (1 mentions)
Pentacam hr, by Oculus (1 mentions)
Opegan hi, by Santen (1 mentions)
Ha powder, by Seikagaku (1 mentions)
Opegan hi, by Seikagaku (1 mentions)
Discovisc, by Alcon (1 mentions)
Viscoat, by Alcon (1 mentions)
Levofloxacin, by Santen (1 mentions)
6 protocols using opegan
1
Posterior Chamber ICL Implantation Procedure
2
Femtosecond Laser-Assisted LASIK and Toric ICL Implantation
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For FS-LASIK, the flap was created with a WaveLight FS200 femtosecond laser system (Alcon, USA). The parameters were performed with an intended flap diameter of 8.5 mm, a thickness of 110 μm, a superior hinge, and a side angle cut of 90°. Excimer laser ablation was performed using a WaveLight EX500 Excimer Laser system (Alcon, USA) with an optical zone of 6 mm and pupil tracking technology. The kappa angle of the treatment centration was adjusted based on the Pentacam HR (Oculus Optikgeräte GmbH) before surgery, and the center was fixated intraoperatively.
For Toric ICL implantation, all of the patients underwent 2 preoperative peripheral iridotomies with a neodymium-YAG laser. Patients were marked on the 0°–180°axis using a slit lamp before surgery. After topical anesthesia was administered, a Toric ICL was inserted through a 2.8 mm clear corneal incision with the use of an injector cartridge (STAAR Surgical) after placement of a viscosurgical device (OpeganTM; Santen, Osaka, Japan) into the anterior chamber. Then, the Toric ICL was placed in the posterior chamber and rotated to the intended axis using the manipulator.
For Toric ICL implantation, all of the patients underwent 2 preoperative peripheral iridotomies with a neodymium-YAG laser. Patients were marked on the 0°–180°axis using a slit lamp before surgery. After topical anesthesia was administered, a Toric ICL was inserted through a 2.8 mm clear corneal incision with the use of an injector cartridge (STAAR Surgical) after placement of a viscosurgical device (OpeganTM; Santen, Osaka, Japan) into the anterior chamber. Then, the Toric ICL was placed in the posterior chamber and rotated to the intended axis using the manipulator.
3
Comparative Analysis of Ophthalmic Viscosurgical Devices
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Table 2 shows the OVDs used in this study. Opegan®, Opegan-Hi®, and Shellgan® were purchased from Santen Pharmaceutical Co., Ltd (Osaka, Japan). Opelead® was purchased from Senju Pharmaceutical Co., Ltd (Osaka, Japan). These four products are distributed in Japan. Viscoat® and Discovisc® were purchased from Alcon Inc. (Hünenberg, Switzerland), which are distributed worldwide. A 3% hyaluronic acid (HA) solution was prepared by dissolving HA powder (derived from chicken combs, Seikagaku Corp., Tokyo, Japan) in phosphate buffered saline at a final concentration of 3%.
OVD products investigated in this study
| Bland name | Composition | Distributor | Mw (kDa) | Classification [1 (link)] | Apparent viscosity (Pa s) | |
|---|---|---|---|---|---|---|
| HA | CS | |||||
| Opegan | 1% HA with low Mw | Santen | 1100 | – | Very low viscosity dispersive | 5.1 |
| Opelead | 1% HA with medium Mw | Senju | 1700 | – | Medium viscosity dispersive | 34.6 |
| 3% HA | 3% HA with low Mw | Homemade | 700 | – | Unreported | 35.2 |
| Viscoat | 3% HA and 4% CS | Alcon | 700 | 20 | Medium viscosity dispersive | 61.7 |
| Shellgan | 3% HA and 4% CS | Santen | 700 | 50 | Medium viscosity dispersive | 73.0 |
| Discovisc | 1.65% HA and 4% CS | Alcon | 1600 | 20 | Viscous dispersive | 117.0 |
| Opegan-Hi | 1% HA with high Mw | Santen | 2500 | – | Viscous cohesive | 62.7 |
Molecular weights (Mw) of HA and chondroitin sulfate (CS) and apparent viscosity of OVDs at shear rate 1 (1/s) have already been determined [14 (link), 15 (link)]
4
Standardized ICL Implantation Technique
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All ICL implantation surgeries were performed using a standardized method in all surgical centers. After topical anesthesia, ICL was inserted through a 3-mm clear corneal incision using an injector cartridge (STAAR Surgical) after placement of a viscosurgical device (Opegan; Santen, Osaka, Japan) into the anterior chamber. The ICL was placed in the posterior chamber, the viscosurgical device was completely washed out of the anterior chamber with a balanced salt solution, and a myotic agent was instilled. All surgeries were uneventful, and no intraoperative complication was observed. After surgery, steroids (0.1% betamethasone; Rinderon; Shionogi, Osaka, Japan) and antibiotics (0.3% levofloxacin; Cravit; Santen, Osaka, Japan) were topically administered four times daily for two weeks, and the dose was gradually reduced thereafter.
5
Cataract and Glaucoma Surgical Procedure
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All procedures were performed by a single surgeon (RA) at Seirei Hamamatsu General Hospital between April 2020 and January 2022. All surgeries were performed under topical anesthesia. Phacoemulsification with intraocular lens implantation in the posterior chamber was performed through a clear corneal incision of 2.4 mm in length. After successful lens implantation involving eyes in the µLOT group, the trabecular meshwork was incised through two quadrants using a trabeculotomy microhook. In the case of eyes in the iStent group, the anterior chamber was filled with Opegan (Santen Pharmaceutical Co., Japan), and the iStent was injected under direct visualization into the nasal angle into Schlemm’s canal using a Swan-Jacob gonioprism lens (Ocular Instruments, Bellevue, WA, USA). Postoperatively, patients received both topical anti-inflammatory medication (Bromfenac Sodium Hydrate Ophthalmic Solution 0.1%, two times daily) and topical antibiotic (Moxifloxacin Ophthalmic Solution 1.5%, four times daily) for 6 weeks. All antiglaucoma medications prescribed preoperatively in glaucoma patients (in the µLOT or iStent group) were discontinued after the surgery. These medications were resumed at the discretion of the attending physician in the postoperative follow-up.
6
Surgical Procedure for Hole ICL Implantation
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The surgical procedures of Hole ICL implantation were as follows (Shimizu et al. 2012a,b; Kamiya et al. 2013 ): on the day of surgery, the patients were administered dilating and cycloplegic agents. After topical anaesthesia, a model V4 ICL was inserted through a 3-mm temporal clear corneal incision with the use of an injector cartridge (STAAR Surgical) after placement of a viscosurgical device (Opegan; Santen, Osaka, Japan) into the anterior chamber. After the ICL was located in the posterior chamber, the viscosurgical device was fully washed out of the anterior chamber with balanced salt solution, and a miotic agent was instilled. The patients did not undergo any preoperative laser iridotomies or intraoperative peripheral iridectomy. Postoperatively, steroidal (0.1% betamethasone; Rinderon; Shionogi, Osaka, Japan) and antibiotic (0.3% levofloxacin; Cravit; Santen, Osaka, Japan) medications were administered topically 4 times daily for 2 weeks, the dose being reduced gradually thereafter.
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