Which is the best ophthalmic viscoelastic device (OVD)?


There is still no consensus on the ‘best OVD’. For routine cases, I only use a cohesive viscoelastic (Healon, Ophthalin) mainly during the capsulorrhexis and the IOL implantation steps where a deep stable anterior chamber is desired. For hard nuclei or in cases with borderline corneal endothelium function, dispersive OVD is also needed to protect the cornea and the best dispersive OVD in my experience is Viscoat. In this case, I inject the dispersive OVD first and then place the cohesive OVD underneath to form a soft shell as described by Steve Arshinoff.1
Healon5 is a viscoadaptive OVD that combines cohesive with dispersive properties and therefore can be used in both routine and complex cataract during cataract surgery.2
Moreover, it is a useful tool in managing cases with small pupils intraoperatively. The highly concentrated long-chained molecules of Healon5 are able to move the iris effectively and dilate the pupil more than any other OVD.

Caution is needed when using Healon5 as overfilling the anterior chamber can result in difficult manipulation of the anterior capsule and can also predispose to phacoburn.3 Creating a fluid space around the phaco tip before phacoemulsification should circumvent these problems. This can be performed by partially filling the anterior chamber with the OVD and injecting balanced salt solution (BSS) underneath, as described by Arshinoff in the ultimate soft-shell technique.2

  1. Dispersive-cohesive viscoelastic soft shell technique. Arshinoff SA. J Cataract Refract Surg. 1999 Feb;25(2):167-73
  2. Using BSS with viscoadaptives in the ultimate soft-shell technique. Arshinoff SA. J Cataract Refract Surg. 2002 Sep;28(9):1509-14.
  3. Healon5 and corneal wound burn during phacoemulsification. Sallam A, Kashani S, Sherafat H.J Cataract Refract Surg. 2007 May;33(5):754

 

Ahmed Sallam, PhD, FRCS, FRCOphth