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Cataract Surgery | Nov/Dec 2012

A Transparent Choice

Experience with a viscoadaptive OVD.

Choosing the most effective ophthalmic viscosurgical device (OVD) can help a surgeon to achieve optimal results after cataract surgery. Therefore, when I am evaluating an OVD, I consider the following: Does it provide excellent transparency and visibility? Does it maintain space in the anterior chamber? Does it adequately protect the endothelium and ensure overall stability of the ocular structures? 1-3 If answers to the above are yes, I consider proceeding with its use, which was the case recently with the cohesivedispersive OVD BiVisc (Cima Technology, Inc.). This viscoadaptive OVD, formed from 2% sodium hyaluronate and 3% sodium chondroitin sulfate, is useful for coating the cornea, providing anterior chamber stability, and maintaining space.

In comparison with Viscoat (sodium chondroitin sulfate, sodium hyaluronate; Alcon Laboratories, Inc.), which in my experience does not always provide clear visibility during surgery, BiVisc remains clear and transparent in the eye. Additionally, some surgeons report that small crystalline lens particles catch up in the OVD material during phacoemulsification; however, I have found that BiVisc keeps lens fragments from fracturing and getting stuck in the OVD material. The cohesive properties of BiVisc enable elasticity, providing good maintenance of space and easy removal, and its dispersive qualities provide low surface tension, enabling effective endothelial coating.


In a recent randomized, prospective study, we compared the performance of BiVisc with Healon (sodium hyaluronate; Abbott Medical Optics Inc.). In total, 20 patients underwent phacoemulsification and IOL implantation, 10 with BiVisc and 10 with Healon. Postoperative visual results were comparable between the groups (Figure 1); however, Healon seeped from both paracentesis ports and the coaxial incision during phacoemulsification, causing diminished endothelial protection. As a result, a 0.5-mL bolus of Healon was not enough to complete the procedure, requiring the surgeon to reinject more OVD into the eye to maintain protection and space during surgical maneuvers. In the same study, one syringe of BiVisc per case was enough to complete the procedure, and we found that this OVD did not seep from the incision sites during capsulorrhexis, hydrodissection, and phacoemulsification. Because the OVD kept the lens fragments from fracturing during phacoemulsification, the procedures were completed safely and efficiently.

The dual properties of BiVisc work together to provide retention, protection, and transparency from start to finish of cataract surgery

Erik L. Mertens, MD, FEBOphth, is Medical Director of Medipolis, Antwerp, Belgium and a Chief Medical Editor of CRST Europe. He states that he has no financial interest in the products or companies mentioned and acknowledges that William Ranson, an independent consultant to Cima Technology, Inc., was responsible for the data mentioned in this article. Dr. Mertens may be reached at tel: +32 3 828 29 49; e-mail: e.mertens@medipolis.be.

  1. Bissen-Miyajima H. Ophthalmic viscosurgical devices. Curr Opin Ophthalmol. 2008;19:50-54.
  2. Storr-Paulsen A, Nørregaard JC, Farik G, Tårnhøj J. The influence of viscoelastic substances on the corneal endothelial cell population during cataract surgery: a prospective study of cohesive and dispersive viscoelastics. Acta Ophthalmol Scand. 2007;85:183-187.
  3. Miller KM, Colvard DM. Randomized clinical comparison of Healon GV and Viscoat. J Cataract Refract Surg. 1999;25:1630-1636.