A primer on ocular viscosurgical devices

Abstract

Purpose To provide pharmacists with an overview of ocular viscosurgical devices (OVDs) and a comprehensive resource describing characteristics of commercially available agents. Summary OVDs are substances that are injected into the eye during ophthalmic procedures, such as cataract surgery, to reduce injury to the endothelium that may result from surgical manipulation. Currently available OVDs are composed of one or more of the following active ingredients: sodium hyaluronate, sodium chondroitin sulfate, and hydroxypropylmethylcellulose. Rheologic properties of OVDs, such as viscosity, elasticity, pseudoplasticity, and cohesion, affect the products’ function and performance. Based on rheologic properties, OVDs can be generally classified as cohesive or dispersive. Given each products’ unique characteristics, OVDs are not interchangeable. An understanding of OVD characteristics and role in practice allows for improved product selection, which varies based on patient characteristics and procedure. Availability of OVD information and literature is generally lacking since OVDs are regulated by the US Food and Drug Administration (FDA) as medical devices. This primer includes an overview of relevant ophthalmic surgical practices and the landscape of comparative efficacy and safety literature to assist in formulary decision-making. This review also provides a comprehensive guide to commercially available OVDs and a discussion on practical considerations for the pharmacist. Conclusion Pharmacists may be tasked with handling OVDs in institutional settings. Knowledge about OVD rheologic properties, product characteristics, role in practice, and available literature is necessary for managing formularies and ensuring optimal product selection.

Causes and management strategies for elevated intraocular pressure after implantable collamer lens implantation

“…The initial surge in IOP following ICL implantation occurs on the first day postoperatively, primarily due to the mechanical obstruction of the trabecular meshwork caused by residual ophthalmic viscosurgical devices (OVD) ( 9 ). OVDs are commonly utilized in intraocular surgeries to maintain anterior chamber stability and protect corneal endothelial cells during the surgical process ( 10 ). Early postoperative elevated IOP due to residual viscosurgical substance in ICL surgery often presents with unbearable eye pain and corneal epithelial edema.…”

Comparison of the Residual Amount of an Ophthalmic Viscosurgical Device Among Different Types of Intraocular Lens Implants in vitro

“… 1 , 2 OVDs are polymer gels composed mainly of hyaluronic acid and ingredients, such as sodium chloride, disodium hydrogen phosphate hydrate, sodium dihydrogen phosphate, sodium phosphate, and a pH adjuster; they are used in ophthalmology and other specialties, such as orthopedics and plastic surgery. OVDs are not toxic to the human body, 3 , 4 but after cataract surgery, various complications are caused by residual OVDs in the capsule. These include high intraocular pressure, IOL dislocation/displacement, endophthalmitis due to bacteria entering the eye with OVD, and toxic anterior segment syndrome.…”

Intraocular pressure before and after capsulorhexis using two viscoelastic substances and two surgical approaches in enucleated porcine eyes

“…T he introduction of ophthalmosurgical viscoelastic devices (OVDs) has improved the safety of cataract surgery significantly [1][2] . As cataract surgery is one of the most frequent surgical procedures [3] any improvement of the surgery unfolds a huge impact globally.…”

“…Based on rheologic properties, OVDs can be generally classified as cohesive or dispersive. Given each products' unique characteristics, OVDs are not interchangeable [1][2] . Prolonged adhesion to the corneal endothelium enhances endothelial protection [2,6] .…”

“…It shows good adherence to intraocular structures including the corneal endothelium protecting this sensitive tissue during surgery [5][6]10] . It is postulated, that it stays longer in the anterior chamber during surgery, but its ability to keep the anterior chamber deep is said to be not as good as with HA [1][2] . This study investigates the intraocular pressure (IOP) at different steps of cataract surgery using OVDs with different properties in a porcine ex vivo model.…”