• Users Online: 1253
  • Home
  • Print this page
  • Email this page

   Table of Contents      
Year : 1989  |  Volume : 37  |  Issue : 2  |  Page : 64-66

Methylcellulose-a better viscosurgical alternative for intraocular lens implantation

Director, Institute of Clinical Ophthalmology, 1 -100 Umeda, Kiryu, Gunma, 376 - 06, Japan

Correspondence Address:
Akira Momose
Director, Institute of Clinical Ophthalmology, 1 -100 Umeda, Kiryu, Gunma, 376 - 06
Login to access the Email id

Source of Support: None, Conflict of Interest: None

PMID: 2583781

Rights and PermissionsRights and Permissions

The authors have used 2% methylcellulose in 8,000 cases of intraocular lens implant surgery during the last five and a half years. Their surgical experience and investigations have convinced them that methylcellulose is safe and effective besides being convenient and economical. It is easily autoclavable, has very low particulate matter when prepared by the author's technique, and causes minimal secondary rise of intraocular pressure. The endothelial protective function and breakdown of the blood aqueous barrier are comparable to that of Healon. The authors consider methylcellulose to be the better alternative for IOL implant surgery.

Keywords: Methylcellulose, IOL implantation, Technique of preparation, Particulate Matter, Systemic Safety, Endothelial Cell Loss, Postoperative Glaucoma.

How to cite this article:
Momose A, Kasahara A. Methylcellulose-a better viscosurgical alternative for intraocular lens implantation. Indian J Ophthalmol 1989;37:64-6

How to cite this URL:
Momose A, Kasahara A. Methylcellulose-a better viscosurgical alternative for intraocular lens implantation. Indian J Ophthalmol [serial online] 1989 [cited 2023 Nov 30];37:64-6. Available from: https://journals.lww.com/ijo/pages/default.aspx/text.asp?1989/37/2/64/26090

Table 1

Click here to view
Table 1

Click here to view

  Introduction Top

The role of viscosurgical substances in intraocular surgery is well establised. Methylcellulose has been used in intraocular lens (IOL) implant surgery for a decade or more [1],[2] . However, its wider use has been limited by fears about particulate con­tamination [3] , uncertainly about its effect on the endothelium and blood aqueous barrier-and paucity of reports in the litera­ture about safe and efficacious use of the substance in a large series.

The first author has used methylcellulose prepared in his phar­macy for the last five and a half years in over 8000 cases of intraocular lens implantation. The authors found methylcel­lulose prepared by their technique to be a better alternative as compared to the other available viscosurgical substances. This surmise is based on the authors' surgical experience [5] , their studies on particulate contamination in available vis­cosurgical substances [4] , their observations on endothelial damage [5] and postoperative intraocular pressure [6] after the sur­gical use of different viscous substances, reported results of a study on postoperative breakdown of blood aqueous barrier [7] and economic considerations.


The material is the medical use grade hydroxypropylmethyl­cellulose which is commercially available as Methocel ® E - 4M Premium (Dow Chemical Corporation). 10 g of Methocel ® E- 4M Premium is dissolved in 150 ml of B.S.S.® (Alcon Laboratories, Inc ), then warmed to about 90°C and stirred well. Ice bath chilled BSS® is added to the above solution to make it upto 500ml. This 2 % Methocel solution is poured in to a glass bottle, tightly closed by a glass stopper and preserved for one night in a refrigerator at 0°C to -10°c. The solution is then warmed to 40°C to reduce its vis­cosity and filtered by MILLI FIL ® PF (Millipore® : pore size 0.811) connected to a Millipore® tube pump [Figure - 1] (Alterna­tively, for small quantities, a 10 - 20ml injection syringe may be used instead of the pump). The filtered solution is poured into 3 ml vials and sealed with a rubber stopper and aluminium cap. It is packed in a sterilizing bag and autoclaved at 120° C for 30 minutes. Methylcellulse solution is aspirated into a 1.0ml syringe through a 16G needle when it is used or it may be contained in a special syringe developed for this purpose . At this time care should be taken not to withdraw air bubbles.


Ease of Preparation and cost

The easy preparation of a safe autoclavable methylcellulose at a minimal cost makes it extremely suitable for use. This is particularly significant in the developing countries, where few can afford a viscosurgical substnce at a prohibitive cost. Methylcellulose solution can be used in hundreds of cases for the same cost as 0.4 ml of Healon®.

Particulate Matter

The number of insoluble particles of various sizes in one ml of five viscosurgical materials were examined by HIAC PC­320 particle size analyzer [4] (HIAC/ROYCO), [Tabe 1], at the Institute of Clinical Ophthalmology. Methylcellulose prepared by the aforementioned technique has been shown to have 10 times less particles of various sizes (1-30mm or more in diameter) as compared to Viscoat®,Amvisc® and Healon® as measured by HIAC PC- 320 particle size analyzer (HIAC/ROYCO). This is contrary to the misgivings on the score reported earlier by Rosen and co- workers [3] , who found a high density of particulate matter in the solutions of methyl­cellulose analysed by them. However, the filters used and filtration methodology employed in the samples studied by them must be different from the authors' present technique.


The medical use grade methylcellulose is hydroxypropyl­methylcellulose. It consists of two molecules of glucose that bind to form cellobiose, a molecule that human bodies are sup­posedly unable to breakdown. The process by which methyl­cellulose is cleared from human bodies is at present unknown [1],[8] . However, this seems to be without any clinical significance. Methylcellulose has long been used for emul­sification in injectable medicines such as prednisolone acetate and hydrocortisone acetate. It has also been used oral­ly in large doses in soft icecreams without any known side ef­fects. The doses used intraocularly are comparatively minute and not likely to cause any toxicity.

Ease of IOL Manipulation

2 %Methylcllulose has the ideal viscosity for IOL implanta­tion. The authors have observed that 'in the bag' placement of the IOL is easier when using methylcellulose than with more viscous Healon®. With Healon® the lens tends to be pushed back when placing the inferior haptic `in the bag',especially in an IOL with polypropylene loops. Fig. il­lustrates the resistance felt by the polypropylene loops in Healon and Methylcellulose respectively. The IOL sinks into methylcellulose solution smoothly by its gravity but not in Healon®.

Without considering the cost, methylcellulose may be rein­jected whenever the anterior chamber tends to shallow, as it is inexpensive. Thus the disadvantage of relatively lower vis­cosity, if any, is easily offset in most cases. However, Healon® may be more useful in unusually hard eyes. Heal one is also more useful when cataract surgery is com­bined with keratoplasty i.e. the triple procedure.

Endothelial Cell Loss and Effect on Blood Aqueous Barrier

It has been observed that endothelial cell loss is lower with the use of methylcellulose during IOL implantation as com­pared to air [2],[5] . The study done at the Institute of Clinical Oph­thalmology [5] also demonstrates that the difference in the endothelial cell loss when using Healon® (20.7± 15.6%, 178 cases) and methylcellulose (18.1 ± 14.9% 205 cases) was not statistically significant [5] . It has been demonstrated by fluorophotometric study that the disruption of blood aqueous barrier with the use of methylcellulose in intraocular surgery is similar to that with sodium chondroitin sulphate or sodium hyaluronate [7] .


Post-operative glaucoma is not a frequent problem with methylcellulose, especially if it is washed out at the end of surgery. The occurrence of intraocular pressure (IOP) over 25 mm Hg postoperatively in a series of 205 cases was 7.3 % [5] . However no patient had any symptoms or required any treat­ment, as the IOP returned to normal in all cases within a few days. This may be attributed to the water solubility of methyl­cellulose which eases the drainage of methylcellulose from the anterior chamber. A lower count in particulate matter of methylcellulose which may obstruct the trabecular mesh­work, may also account for its low potential for elevated IOP. The authors, therefore, consider methylcellulose to be a bet­ter alternative for IOL implantation and advocate its routine use for the purpose.

  References Top

Fechner, P.U. and Fechner, M.V. : Methylcellulose and lens implantation. Brit. J. Ophthamol. 67:257-263:1983.  Back to cited text no. 1
Arm-Rosa, D., Cohn, H.C., Aron, JJ. and Bouquety,C.: Methylcellulose instead of Healon in extracapsular surgery with intraocular lens implantation Ophthalmol­ogy, 90:1235-1238:1983.  Back to cited text no. 2
Rosen, E.S., Gregory, RP.F.,Bamett, F.: Is 2% Hydroxypropyhnethylcellulose a safe solution for intraoperative clinical applications? J. Cataract Refract. Surg. 12:679- 684:1986.  Back to cited text no. 3
Momose, A., Baba, T. and Kazahara, A.: Particles in Viscosurgical Materials. J.Eye (Atarashii Ganka) 5:314-316:1988.  Back to cited text no. 4
Momoge, A. and Baba, T.: ViwAxturgery, Healon versus Methylcellulose. Presented at Japan-Korea Ophthalmology Symposium II, Proceedings 65-69:1984.  Back to cited text no. 5
Momose, A., Baba, T. and Kasahara, A.: Use of methylellulose in cataract surgery. IOL (Japanese)1:147-151:1987.  Back to cited text no. 6
Miyake, T.:Fluorophotometric evaluation of the blood-ocular barrier function fol­lowing cataract surgery and intraocularlens implantation. J. cataract Refract. Surg. 14:560-568:1988.  Back to cited text no. 7
Edelhauser, H.F. and Mac Rae, S.M.: Irrigating and viscous solutions. In sears, M.L. and Tarkkanen, A. Editors: Surgical Pharmacology of the eye. New York Raven Press, p. 363-388:1985.  Back to cited text no. 8


  [Figure - 1]

  [Table - 1]


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

  In this article
Article Figures
Article Tables

 Article Access Statistics
    PDF Downloaded0    
    Comments [Add]    

Recommend this journal