Safety and efficacy of hypertonic saline solution (5%) versus placebo in the treatment of postoperative corneal edema after uneventful phacoemulsification: a randomized double-blind study

Purpose To evaluate safety and efficacy of hypertonic saline solution administration after uneventful cataract surgery. Design Prospective double-blind randomized study Methods In total, 183 eyes of 183 patients undergoing phacoemulsification were randomly allocated into two equal groups. Treatment group (TG) subjects received single-dose hypertonic (NaCl 5%) solution 4 times daily for 14 days, while placebo group (PG) received single dose of normal saline solution (0.9%) at the same frequency in addition to ordinary postoperative treatment. All patients underwent assessment of central corneal thickness (CCT), endothelial cell density (ECD), best-corrected visual acuity (BCVA), clinical staging of postoperative corneal edema and questionnaire regarding the procedure success and impact on patient’s life. Measurements were taken at baseline and 1, 4, 9 and 30 days following surgery. Results CCT increased by 134.67 ± 94.51 μm (25.1 ± 19.4%) on postoperative day 1, without any difference between study groups ( p = 0.58). Corneal edema showed a significant recession in TG compared to PG on day 4, in terms of both pachymetry (10.73% vs 7.39%, p = 0.004), BCVA (BCVA TG = 0.64 ± 0.24 [logMAR TG = 0.25 ± 0.3], BCVA PG = 0.56 ± 0.23 [logMAR PG = 0.33 ± 0.3], p = 0.04) and clinical staging ( p = 0.02). Similar results were recorded on postoperative day 9 in subjects demonstrating marked corneal edema on the first postoperative day. Endothelial cell loss showed no statistically significant difference between study groups ( p = 0.48). No adverse events were recorded in relation to treatment. More patients in the TG (92.4% vs 57.1% in the PG) reported a subjectively clear vision 1 week postoperatively ( p = 0.04). Conclusion The use of 5% hypertonic saline solution is found to be a safe and effective adjunct in the management of postoperative corneal edema after uneventful phacoemulsification, achieving rapid corneal clearance and expediting a good visual outcome, especially in cases with marked postoperative edema.