Ophthalmic Viscosurgical Devices for Modern Cataract Surgery

Ophthalmic viscosurgical devices (OVDs; previously known as viscoelastics) are the primary tools used by ophthalmic surgeons to create the physical environments that can optimally enhance the facility of performance of the controlled, delicate intraocular maneuvers in modern anterior segment eye surgery of all types, most particularly cataract surgery. Since the introduction of Healon (Advanced Medical Optics) in 1979, 1 OVDs have proliferated and become essential in anterior segment surgery for space creation, tissue stabilization, balancing pressure between the anterior and posterior segments of the eye, spatial partitioning to isolate specific areas from fluid turbulence, and protection of the corneal endothelial cells from surgical trauma, free radicals, and other surgical hazards. 2 Understanding the unique physical characteristics of a given surgical environment that need to be controlled in surgery (especially when faced with a circumstance that alters the “usual” environment) and the different properties of the available OVDs, allows the surgeon to perform in a customized, more stable, and safer environment, and makes his or her surgery simpler and smoother in its execution. Before addressing the specific spatial problems encountered in surgery and how to deal with them, some understanding of the properties of the palette of OVDs available is important. The goal should always be to create an environment in which a given task can be performed easily, rather than learning to perform heroically in a difficult, unstable, and uncontrolled environment.