Viscoelastic Substances
Viscoelastic substances, such as hyaluronic acid, should be used with caution in eyes with glaucoma. They are especially useful during the anterior capsulotomy, not only for maintaining a deep anterior chamber and protecting corneal endothelium but also for providing additional pupillary dilatation. However, viscoelastic substances increase the risk of an early postoperative IOP rise and should be thoroughly aspirated and irrigated from the eye by the end of the procedure. There were no significant differences in postoperative IOP spikes in one study when Healon 5, Healon, and Healon GV were used, although viscoelastics with lower viscosity appear to cause less elevation in IOP (83).
