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B. Lundgren, M. Lundqvist, S. Nilsson; 3D-Evaluation of Viscoadaptive Ophthalmic Viscosurgical Devices (OVDs) During Cataract Surgery Using the Pentacam Scheimpflug Camera. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5393.
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© ARVO (1962-2015); The Authors (2016-present)
Phacoemulsification with use of an OVD is the preferred technique of modern cataract surgery. The OVD maintains the anterior chamber, protects the corneal endothelium and facilitates IOL implantation. By using viscoadaptive OVDs the benefits of both the cohesive (anterior chamber stabilization) and dispersive (corneal protection) features can be utilized. The purpose of this study was to objectively evaluate the performance of the viscoadaptive Healon5 OVD (AMO) with Microvisc Phaco (BD/ Bohus Biotech) and the viscous dispersive OVD, Discovisc (Alcon), during simulated cataract surgery.
Cataract surgery was simulated ex vivo in porcine eyes. OVDs were stained with fluorescein for detection purposes. Each step in the surgeries (before surgery, after OVD injection, after hydrodissection, and after phacoemulsification) was monitored by multiple Scheimpflug photographs using the Pentacam HR (Oculus) and anterior chamber depths were measured. The tomography 3D-model was used to further visualize and evaluate the OVD performance. Three different phacoemulsification flow and vacuum settings (low, medium, and high) were used in order to cover the most clinically relevant settings.
This Scheimpflug camera study reveals superior properties of Healon5 OVD as the only OVD with consistent anterior chamber behavior throughout the study. Among the tested OVDs, Healon5 was the only OVD that stayed in close contact with the corneal endothelium during phacoemulsification. In approximately half of the surgical cases with Microvisc Phaco or Discovisc these OVDs were partly or completely detached from the corneal endothelium by the end of phacoemulsification. The 3D tomography visualized these findings further in an objective way.
Of the three different OVDs tested, only the Healon5 OVD showed true viscoadaptive behavior, meaning consistent anterior chamber maintenance capacity and good retention during all phacoemulsification settings tested. Even though the other tested OVDs were still present in the anterior chamber, their loose positioning gives less control of endothelium protection. The Pentacam 3D tomography software tool can objectively visualize differences in OVD behavior during cataract surgery.
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