Surgeon shares his OVD preferences and techniques

Steve Arshinoff, M.D., clinical instructor of ophthalmology, University of Toronto, Toronto, uses a lot of ophthalmic viscosurgical devices (OVDs)—just not any with hydroxypropyl methylcellulose (HPMC). “The reason I don’t is simply because they’re not very viscous and not very elastic,” said Dr. Arshinoff. “In terms of what you expect an OVD to do, they are generally the poorest. Some newer modified HPMCs have better viscoelastic properties, but the main reason to use HPMCs is because they are less expensive.”
Dr. Arshinoff believes surgeons will have their OVD preferences, and he shared some of his. Surgeons should keep in mind that there are benefits and drawbacks to any OVD and method of usage, and Dr. Arshinoff is direct abou all of this.
To begin, he said DisCoVisc (sodium chondroitin sulfate, sodium hyaluronate, Alcon, Fort Worth, Texas) can be used successfully for all steps of phacoemulsification. DisCoVisc is the first OVD to combine higher viscosity and dispersion.
“It works for all phaco steps,” Dr. Arshinoff said. “But you can never achieve as much with any single OVD as with a combination of different OVDs. DisCoVisc has middle-of-the-road properties and not extreme proper ties with respect to viscosity and cohesion-dispersion.”
In difficult cases or complications, however, Dr. Arshinoff prefers other OVDs with specific techniques. “We all see 80-year-old patients who have pseudoexfoliation and lenticular instability,” Dr. Arshinoff said. “In those pa tients and other expected complicated cases, I perform a soft shell—or ulti mate soft shell—technique.”
Dr. Arshinoff explained that the soft shell technique can be employed suc cessfully using Viscoat (sodium chondroitin sulfate, sodium hyaluronate, Alcon), a dispersive OVD, and ProVisc (sodium hyaluronate, Alcon), a cohe sive OVD. The two are marketed by Alcon in one disposable package called DuoVisc.
Another technique is to utilize what is known as the ultimate soft shell technique, which Dr. Arshinoff has described as using viscoadaptive OVDs, such as Healon 5 (Abbott Medical Optics, AMO, Santa Ana, Calif.), to block ade space rather than fill it. He described this technique in the September 2002 issue of the Journal of Cataract & Refractive Surgery.
“The ultimate soft shell technique compartmentalizes the anterior cham ber using the ultimate low-viscosity fluid—water,” Dr. Arshinoff wrote. “The use of this technique facilitates cataract surgery with viscoadaptive OVDs and viscoadaptive removal at the end of the procedure.”
Dr. Arshinoff discussed the importance of chondroitin sulfate. “It has a longer residence time in the eye adjacent to corneal endothelial cells. Chon droitin sulfate, when used alone, is a low viscosity Newtonian fluid that is very dispersive,” Dr. Arshinoff said. “It is therefore protective for the cornea. It sits up against endothelial cells and resists being washed away by irrigation.
“Chondroitin sulfate is particularly helpful in variants of the soft shell tech nique when there is a hole in the posterior capsule or broken zonules, and with Healon 5, in IFIS cases, where the fundamental physical role is to parti tion spaces, thereby protecting selected spaces from the turbulence of irriga tion,” he said.
“Generally in surgery, post-op day one corneal edema is minimized by using chondroitin sulfate-containing OVDs like Viscoat.”