Evaluation of the Protective Effect of an Ophthalmic Viscosurgical Device on the Ocular Surface in Dry Eye Patients during Cataract Surgery

Abstract

Purpose: To evaluate the protective effect of applying an ophthalmic viscosurgical device (OVD) to the ocular surface during cataract surgery and its ability to prevent dry eye syndrome. Methods: Twenty-four patients aged 50 to 75 years who underwent cataract surgery at Seoul National University Bundang Hospital and agreed to participate in the study were included and divided into two groups: a study group who underwent cataract surgery after application of an OVD to the ocular surface, and a control group who underwent cataract surgery without application of an OVD. DisCoVisc was used as the OVD in the study group, while other factors including surgical techniques and administration of anesthetic agents were performed in both groups in the same manner. Indicators of dry eye syndrome including ocular staining score, tear break-up time, and tear osmolality were analyzed. Ocular surface disease index and a visual analog scale were analyzed for dry eye symptoms, and the amount of balanced salt solution used during surface irrigation and operation time were also analyzed. Results: Significant improvement in the tear break-up time, corneal ocular staining score, and ocular surface disease index score in the study group compared with the control group one week after operation (by the Mann-Whitney test). Use of OVD was associated with longer operating time. Conclusions: OVD applied to the ocular surface during cataract surgery had a protective effect on the ocular surface one week after surgery.

Cataract surgery and dry eye disease: A review

“…Likewise, Yoon et al. 74 in a comparative prospective study of 24 patients, reported the use of an ophthalmic visco-surgical device (OVD) (DisCoVisc, Alcon Laboratories, Inc.) intra-operatively to coat the ocular surface and found significant improvements in TBUT, OSDI scores and ocular surface staining scores at 1 week post-surgery. These improved outcomes with ocular surface coating with OVDs are supported by the studies of Oh et al.…”

“…As discussed above, there are several intra-operative factors that may be important in the pathophysiology of cataract surgery-induced iatrogenic DED including corneal nerve damage secondary to surgical incisions; the potentially toxic effects of povidone-iodine and topical anaesthetic drops on the ocular surface; repeated ocular surface drying/irrigation; phototoxicity; and direct ocular surface trauma. 51 , 55 – 78 , 83 – 85 The cataract surgeon needs to be mindful of these factors when operating on patients, especially when a patient has any pre-existing DED 17 , 18 , 47 , 48 , 97 ( Table 1 ).…”

“…In cases with severe DED, surgeon’s use of the larger incision astigmatic keratotomies/LRIs should be carefully considered in order to limit additional corneal nerve trauma, 61 , 62 and alternatives such as toric intraocular lenses should be considered. The use of a dispersive OVD such as HMPC 2% on the ocular surface during cataract surgery may have protective effects, with prospective randomized and non-randomized studies showing benefits in reduced symptoms and signs of DED post-operatively 72 – 74 and it is the authors’ choice to coat the ocular surface with an OVD in eyes with pre-existing DED during cataract surgery. Finally, to limit post-operative DED it is sensible that the use of any peri-operative topical medications needs to be both appropriate and not excessive, direct ocular surface trauma is kept to a minimum with careful tissue handling, operative light exposure is appropriate for surgical visualization and not excessive, and operative/ocular exposure times are minimized by careful surgical planning.…”

Iatrogenic Dry Eye Disease: Dealing with the Conundrum of Post-Cataract Discomfort. A P.I.C.A.S.S.O. Board Narrative Review

“…Moreover, a recently published study showed that the use of this intracameral solution during cataract surgery could reduce ocular surface inflammation evaluated by in vivo confocal microscopy, assuring a better postoperative tear film stability and visual quality [ 47 ]. A recent report [ 48 ] has also indicated that persistent intraoperative surface irrigation may contribute to immediate postoperative dry eye symptoms. Applying an ophthalmic viscosurgical device (OVD) on the corneal surface during surgery results in less ocular surface damage than balanced salt solution (BSS) irrigation on the surface, providing the advantage of a clear surgical view with no difference in surgical time [ 48 , 49 ].…”

“…A recent report [ 48 ] has also indicated that persistent intraoperative surface irrigation may contribute to immediate postoperative dry eye symptoms. Applying an ophthalmic viscosurgical device (OVD) on the corneal surface during surgery results in less ocular surface damage than balanced salt solution (BSS) irrigation on the surface, providing the advantage of a clear surgical view with no difference in surgical time [ 48 , 49 ].…”