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Cohesive OVD with dispersive characteristics provides flexibility
Amvisc Plus is a moderately cohesive viscoelastic with dispersive characteristics, according to one surgeon.
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![Uday Devgan, MD, FACS [photo]](/images/commonart/devgan.jpg) Uday Devgan |
The combination of characteristics of Bausch & Lomb’s Amvisc Plus allow it to be well-retained in the anterior chamber during phacoemulsification and yet easily removed during irrigation and aspiration at the end of the procedure, according to Uday Devgan, MD, FACS.
Dr. Devgan said Amvisc Plus (sodium hyaluronate, Bausch & Lomb) is a moderately cohesive ophthalmic viscosurgical device (OVD) with dispersive characteristics.
“During cataract surgery it is beneficial to have the best of both worlds,” Dr. Devgan said in an e-mail interview.
A cohesive viscoelastic produces a deep anterior chamber and flat anterior capsule for capsulorrhexis. A cohesive material also creates and maintains space for IOL insertion and allows tissue manipulation, such as repositioning a floppy iris, he said.
While these cohesive properties are important, Dr. Devgan said dispersive properties are equally important to protect the endothelium and lubricate the IOL injector.
“Having a viscoelastic that is versatile enough to be used at all steps during the procedure simplifies the case and reduces costs,” he said.
OVD diversity
Cataract surgeons should have a full spectrum of viscoelastic choices in the operating room, said Dr. Devgan, who is OSN Cataract Surgery section member and OSN Back to Basics column author.
“No viscoelastic will be the perfect choice for every case you do,” he said. “Rather, you want to have a work-horse viscoelastic that performs well in the majority of your cases and then have other types of viscoelastics for use in more challenging cases or difficult situations.”
Dr. Devgan said he uses Amvisc Plus in many of his surgical cases because of its combined cohesive and dispersive characteristics.
In challenging cases he sometimes uses a more dispersive viscoelastic as well as a second OVD, or to add a thin dispersive coat to the corneal epithelium so that the scrub nurse does not have to continually wet the eye with a balanced salt solution.
“I particularly like it in cases where I want to have cohesive properties to deepen an anterior chamber or spread a pupil, but I want to also maintain easy removability and low incidence of IOP rises in case I leave some behind,” he said. “Amvisc Plus provides a best-of-both-worlds level of cohesiveness – cohesive enough to be easily removed, while having dispersive characteristics to achieve lasting chamber retention.”
Injecting viscoelastic properly
When filling the anterior chamber with Amvisc Plus it is important to create a fluid wave, Dr. Devgan said.
This is done by placing the cannula across the anterior chamber and filling the chamber first distally and then proximally.
“While withdrawing your cannula, you can achieve a complete cohesive fill,” he said. “An improperly injected viscoelastic leaves spaghetti-like strings of viscoelastic in the anterior chamber, which do not effectively protect the endothelium.”
Dr. Devgan suggested filling the anterior chamber completely before performing capsulorrhexis.
“The deeper your fill, the flatter the anterior capsule, and the easier it will be to do a well-centered 5-mm round capsulorrhexis,” he said. “I recommend ordering the larger 0.85-cc size so that you have plenty of viscoelastic to fill the anterior chamber before phaco and enough left to load your IOL into the injector and to fill the capsular bag prior to lens insertion.”
Easy removal
According to Dr. Devgan, Amvisc Plus is easily removed after the IOL is in place.
“Removal is fast and efficient, and it is rare for me to have any trapped material behind the IOL or retained in the anterior chamber,” he said. “Therefore, my rate of postop IOP spikes with Amvisc Plus is quite low.”
Dr. Devgan said it is not absolutely critical that every last bit of Amvisc Plus is removed to prevent increased postop IOP.
“If a little is retained, giving the patient systemic acetazolamide for a day or two is usually sufficient to blunt any pressure spikes,” he said.
For Your Information:
- Uday Devgan, MD, FACS, can be reached at 9375 San Fernando Road, Sun Valley, CA 91352; 818-768-3000; fax: 818-504-4463; e-mail: devgan@ucla.edu. Dr. Devgan has no direct financial interest in any products discussed in this article, nor is he a paid consultant for any companies mentioned.
- Bausch & Lomb, maker of AmVisc Plus, can be reached at 1400 Goodman St., Rochester, NY 14609; 585-338-5212; fax: 585-338-0898; Web site: www.bausch.com.
- Daniele Cruz is an OSN Staff Writer who covers all aspects of ophthalmology.