Impact of Ophthalmic Viscosurgical Devices in Cataract Surgery

Abstract

Background. Ophthalmic viscoelastic devices (OVDs) used during small-incision cataract surgery have numerous advantages. However, OVDs have longer retention time in an eye after surgery resulting in intraocular pressure (IOP) spikes. The purpose of this study is to analyze and quantify the effect of various OVDs on both IOP and best corrected visual acuity (BCVA) by systematically reviewing the literature and performing meta-analysis. Methods. Numerous databases from January 1, 1985, to present were systematically searched. Thirty-six (3893 subjects) of 3313 studies identified were included for analysis. Standardized mean difference (SMD) was computed, and meta-analysis was performed. Results. A total of 3313 records were retrieved including 1114 from database search and 2199 from grey literature search. Significant increase in postoperative IOP in 1-day follow-up with Healon (SMD = 0.37, CI: [0.07, 0.67]), Viscoat (SMD = 0.29, CI: [0.13, 0.45]), Provisc (SMD = 0.46, CI: [0.17, 0.76]), and Soft Shell (SMD = 0.58, CI: [0.30, 0.86]) was computed. On the other hand, results implied a nonsignificant increase in postoperative IOP with Healon GV (SMD = 0.07, CI: [−0.28, 0.41]), Healon5 (SMD = 0.15, CI: [−0.33, 0.64]), 2% HPMC (SMD = 0.32, CI: [−0.0, 0.64]), and OcuCoat (SMD = 0.26, CI: [−0.37, 0.9]). Additionally, a nonsignificant reduction in postoperative IOP was inferred with Viscoat + Provisc (SMD = −0.28, CI: [−2.23, 1.68]). Conclusion. Improvement in IOP was shown with Viscoat + Provisc. Additionally, IOP nonsignificant upsurge was observed with Healon GV, Healon5, 2% HPMC, and OcuCoat compared to significant upsurge with Healon, Viscoat, and Soft Shell.

Advantages of Hyaluronic Acid and Its Combination with Other Bioactive Ingredients in Cosmeceuticals

“…The use of artificial tears is the most common therapeutic solution for dry eye syndrome. Tears based on HA and carmellose (carboxymethylcellulose) proved to be superior in terms of stability of the tear film and quality of vision in comparison with normal saline solution [ 26 , 50 , 51 , 52 , 53 , 54 ].…”

Surgical and Perioperative Considerations for the Treatment of Cataract in Eyes with Glaucoma: A Literature Review

“…For a given concentration of the viscoelastic in the AC, the lower the viscosity, the higher and more prolonged the IOP spike. The different viscoelastics demonstrate slightly different behaviours regarding the postoperative effect on IOP depending on their properties, such as molecular charge, chain length, and rigidity [ 8 , 9 ]. The cohesive viscoelastics have larger molecular chains and are aspirated more easily, but may cause higher IOP spikes than the dispersive if not removed, although differences are not great [ 10 ].…”

Ophthalmic Viscosurgical Devices (OVDs) in Challenging Cases: a Review

“…OVDs are currently used in cataract surgery and have significantly improved the safety and effectiveness of this surgical procedure [7,8]. Specifically, OVDs create and maintain anterior chamber depth and visibility as well as protect the corneal endothelium and other intraocular tissues during surgery [7,8].…”

“…OVDs are currently used in cataract surgery and have significantly improved the safety and effectiveness of this surgical procedure [7,8]. Specifically, OVDs create and maintain anterior chamber depth and visibility as well as protect the corneal endothelium and other intraocular tissues during surgery [7,8]. Currently, there are a growing number of commercially available OVDs, differing in rheologically active polymeric substances, concentrations, and chain lengths [9,10].…”

“…The protective effect of OVDs is especially relevant in challenging cases, such as in hard cataract surgery [11] or flat anterior chamber cases [12], minimizing the impact of the surgical procedure on the intraocular tissues and therefore contributing to a faster recovery [7,8]. The aim of the current narrative review was to compile all the scientific evidence concerning the utilization of OVDs in challenging cases, defining specific uses of these substances and their real clinical benefit.…”