{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T00:40:45Z","timestamp":1760402445107,"version":"build-2065373602"},"reference-count":35,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2021,3,30]],"date-time":"2021-03-30T00:00:00Z","timestamp":1617062400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>Phacoemulsification is a widely used surgical method in cataract surgery with a high energy ultrasound source. The viscoelastic is considered to be tissue protective. The aim of this study is to investigate during surgery the impact of using viscoelastic versus no viscoelastic on clinical outcomes, potential complications and effect on endothelial cell density. The study group included 64 patients, who were subjected to phacoemulsification using balanced salt solution (BSS). Control group consisted of 62 patients, who underwent phacoemulsification using Hyaloronic acid 1% Healon 1%. Student\u2019s t-test was applied for statistical analysis. The simulations of temperature changes during phacoemulsification were performed by COMSOL Multiphysics software. In the BSS group, a mean endothelial cell loss (ECL) of 4.5% was measured one month postoperatively, while in the Healon group ECL was 5.3%. Data analysis showed no significant difference in ECL between the groups (Student\u2019s t-test, p = 0.8). No significant difference was observed in endothelial cell morphology and IOP between the two groups pre- and postoperatively (all p &gt; 0.05). The modeling of thermo fluid dynamics showed that the heating of the cornea is slightly less when Healon was used as irrigation fluid. The phacoemulsification technique can be performed by an experienced surgeon with viscoelastics or continuous anterior chamber (AC) irrigation on the same level of safety regarding endothelial cell damage, providing equally satisfying clinical outcomes.<\/jats:p>","DOI":"10.3390\/s21072399","type":"journal-article","created":{"date-parts":[[2021,3,31]],"date-time":"2021-03-31T00:13:10Z","timestamp":1617149590000},"page":"2399","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Phacoemulsification and IOL-Implantation without Using Viscoelastics: Combined Modeling of Thermo Fluid Dynamics, Clinical Outcomes, and Endothelial Cell Density"],"prefix":"10.3390","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8581-3964","authenticated-orcid":false,"given":"Nikola","family":"Goles","sequence":"first","affiliation":[{"name":"Department of Physics, Faculty of Sciences, University of Novi Sad, 21000 Novi Sad, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marko","family":"Nerancic","sequence":"additional","affiliation":[{"name":"Department of Physics, Faculty of Sciences, University of Novi Sad, 21000 Novi Sad, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sanja","family":"Konjik","sequence":"additional","affiliation":[{"name":"Department of Mathematics and Informatics, Faculty of Sciences, University of Novi Sad, 21000 Novi Sad, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brigitte","family":"Pajic-Eggspuehler","sequence":"additional","affiliation":[{"name":"Eye Clinic Orasis, Swiss Eye Research Foundation, 5734 Reinach AG, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1987-6232","authenticated-orcid":false,"given":"Bojan","family":"Pajic","sequence":"additional","affiliation":[{"name":"Department of Physics, Faculty of Sciences, University of Novi Sad, 21000 Novi Sad, Serbia"},{"name":"Eye Clinic Orasis, Swiss Eye Research Foundation, 5734 Reinach AG, Switzerland"},{"name":"Division of Ophthalmology, Department of Clinical Neurosciences, Geneva University Hospitals, 1205 Geneva, Switzerland"},{"name":"Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland"},{"name":"Faculty of Medicine of the Military Medical Academy, University of Defense, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8218-4899","authenticated-orcid":false,"given":"Zeljka","family":"Cvejic","sequence":"additional","affiliation":[{"name":"Department of Physics, Faculty of Sciences, University of Novi Sad, 21000 Novi Sad, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,3,30]]},"reference":[{"key":"ref_1","first-page":"312","article-title":"Prenatal and postnatal cellularity of the human corneal endothelium. A quantitative histologic study","volume":"25","author":"Murphy","year":"1984","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1001\/archopht.1990.01070040099039","article-title":"Normal endothelial cell density range in childhood","volume":"108","author":"Nucci","year":"1990","journal-title":"Arch. Ophthalmol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1006\/exer.2000.0964","article-title":"A histomorphometric study of corneal endothelial cells in normal human fetuses","volume":"72","author":"Ko","year":"2001","journal-title":"Exp. Eye Res."},{"key":"ref_4","first-page":"779","article-title":"Central corneal endothelial cell changes over a ten-year period","volume":"38","author":"Bourne","year":"1997","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1097\/00006324-200110000-00010","article-title":"A population study of the normal cornea using an in vivo slit-scanning confocal microscope","volume":"78","author":"Hollingsworth","year":"2001","journal-title":"Optom. Vis. Sci."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1136\/bjo.62.12.809","article-title":"Specular microscopy of the corneal endothelium","volume":"62","author":"Sturrock","year":"1978","journal-title":"Br. J. Ophtahlmol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1136\/bjo.66.8.513","article-title":"Effect of age on the endothelial cell count in the normal eye","volume":"66","author":"Wilson","year":"1982","journal-title":"Br. J. Ophthalmol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1016\/S0161-6420(82)34746-6","article-title":"The corneal endothelium: Normal and pathologic structure and function","volume":"89","author":"Waring","year":"1982","journal-title":"Ophthalmology"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1038\/eye.1990.53","article-title":"The corneal endothelium","volume":"4","author":"Tuft","year":"1990","journal-title":"Eye"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1001\/archophthalmol.2010.128.63","article-title":"Cornea Donor Study Investigator Group. Endothelial cell density to predict endothelial graft failure after penetrating keratoplasty","volume":"128","author":"Lass","year":"2010","journal-title":"Arch. Ophthalmol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1007\/s10792-007-9087-0","article-title":"Graft failure I: Endothelial cell loss","volume":"28","author":"Claerhout","year":"2008","journal-title":"Int. Ophthalmol."},{"key":"ref_12","first-page":"31","article-title":"The effect of phacoemulsification on the corneal endothelium","volume":"10","author":"Waltman","year":"1979","journal-title":"Ophthalmic. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1001\/archopht.1978.03910050222005","article-title":"The effect of phacoemulsification on corneal endothelial cell density","volume":"96","author":"Sugar","year":"1978","journal-title":"Arch. Ophthalmol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1016\/0002-9394(76)90305-6","article-title":"Endothelial damage associated with intraocular lenses","volume":"81","author":"Bourne","year":"1976","journal-title":"Am. J. Ophthalmol."},{"key":"ref_15","first-page":"996","article-title":"Endothelial damage from intraocular lens insertion","volume":"15","author":"Kaufman","year":"1976","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1016\/S0886-3350(87)80156-6","article-title":"Endothelial cell loss after phacoemulsification and insertion of silicone lens implants","volume":"13","author":"Faulkner","year":"1987","journal-title":"J. Cataract. Refract. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/S0886-3350(13)80042-9","article-title":"Corneal endothelial cell loss after phacoemulsification using nuclear cracking procedures","volume":"20","author":"Hayashi","year":"1994","journal-title":"J. Cataract. Refract. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1097\/ICU.0b013e32834e4b5f","article-title":"The changing fate of the corneal endothelium in cataract surgery","volume":"23","author":"Afshari","year":"2012","journal-title":"Curr. Opin. Ophthalmol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1001\/archopht.1993.01090060119035","article-title":"The Lens Opacities Classification System III. The Longitudinal Study of Cataract Study Group","volume":"111","author":"Chylack","year":"1993","journal-title":"Arch. Ophthalmol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.mbs.2014.06.008","article-title":"Computational modeling of drug distribution in the posterior segment of the eye: Effects of device variables and positions","volume":"255","author":"Jooybar","year":"2014","journal-title":"Math. Biosci."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e3141","DOI":"10.1002\/cnm.3141","article-title":"A novel patient-oriented numerical procedure for glaucoma drainage devices","volume":"34","author":"Mauro","year":"2018","journal-title":"Int. J. Numer. Meth. Biomed. Enging."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1462","DOI":"10.1016\/j.medengphy.2012.02.007","article-title":"3D simulation of the aqueous flow in the human eye","volume":"34","author":"Villamarin","year":"2012","journal-title":"Med. Eng. Phys."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1823","DOI":"10.1007\/s11517-018-1813-4","article-title":"A generalised porous medium approach to study thermo-fluid dynamics in human eyes","volume":"56","author":"Mauro","year":"2018","journal-title":"Med. Biol. Eng. Comput."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1429","DOI":"10.1007\/s10237-019-01156-y","article-title":"A novel numerical modelling approach for keratoplasty eye procedure","volume":"18","author":"Mohamed","year":"2019","journal-title":"Biomech. Model. Mechanobiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"119994","DOI":"10.1016\/j.ijheatmasstransfer.2020.119994","article-title":"Three dimensional heat and mass transfer in human eye based on porous medium approach","volume":"158","author":"Mauro","year":"2020","journal-title":"Int. J. Heat Mass Transf."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1088\/0967-3334\/27\/4\/004","article-title":"Thermography used for analysis and comparison of different cataract surgery procedures based on phacoemulsification","volume":"27","author":"Corvi","year":"2006","journal-title":"Physiol. Meas."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2431","DOI":"10.1016\/j.ultrasmedbio.2014.05.017","article-title":"Computation of the temperature rise at the corneal endothelium during surgery by modeling of heat generation inside anterior chamber","volume":"40","author":"Koch","year":"2014","journal-title":"Ultrasound Med. Biol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1097\/00003226-199105000-00005","article-title":"Indications for penetrating keratoplasty","volume":"10","author":"Lindquist","year":"1991","journal-title":"Cornea"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1001\/archopht.1986.01050130097029","article-title":"An update of the indications for penetrating keratoplasty","volume":"104","author":"Robin","year":"1986","journal-title":"Arch. Ophthalmol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/S0039-6257(99)00085-5","article-title":"Phacoemulsification and modern cataract surgery","volume":"44","author":"Linebarger","year":"1999","journal-title":"Surv. Ophthalmol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1016\/S0002-9394(14)73923-6","article-title":"A comparison of corneal endothelial changes after use of Healon or Viscoat during phacoemulsification","volume":"115","author":"Koch","year":"1993","journal-title":"Am. J. Ophthalmol."},{"key":"ref_32","unstructured":"Buratto, L., Werner, L., Zanini, M., and Apple, D. (2003). Surgical pharmacology: Intraocular solutions and drugs used for cataract surgery. Phacoemulsification; Principles and Techniques, Slack. [2nd ed.]."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1016\/S0002-9394(14)78301-1","article-title":"The effects of sodium hyaluronate, chondroitin sulfate, and methylcellulose on the corneal endothelium and intraocular pressure","volume":"95","author":"MacRae","year":"1983","journal-title":"Am. J. Ophthalmol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1089","DOI":"10.1016\/j.ophtha.2006.08.048","article-title":"Natural course of intraocular pressure after cataract surgery with sodium hyaluronate 1% versus hydroxypropylmethylcellulose 2%","volume":"114","author":"Rainer","year":"2007","journal-title":"Ophthalmology"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1136\/bjo.75.8.476","article-title":"Comparison of the effects of intraocular irrigating solutions on the corneal endothelium in intraocular lens implantation","volume":"75","author":"Matsuda","year":"1991","journal-title":"Br. J. Ophthalmol."}],"container-title":["Sensors"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8220\/21\/7\/2399\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T13:33:12Z","timestamp":1760362392000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8220\/21\/7\/2399"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,30]]},"references-count":35,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2021,4]]}},"alternative-id":["s21072399"],"URL":"https:\/\/doi.org\/10.3390\/s21072399","relation":{},"ISSN":["1424-8220"],"issn-type":[{"type":"electronic","value":"1424-8220"}],"subject":[],"published":{"date-parts":[[2021,3,30]]}}}