MILAN – The continuous evolution of ophthalmic viscosurgical devices has gone hand in hand with major advances in ocular surgery, making the devices an indispensable tool for addressing new types of surgery, according to Steve Arshinoff, MD.
Arshinoff, the Benedetto Strampelli Medal Lecturer at the joint meeting of Ocular Surgery News and the Italian Society of Ophthalmology, discussed the history of ophthalmic viscosurgical devices (OVDs), from the first high-viscosity, cohesive Healon (sodium hyaluronate)— patented by Endre Balazs, MD, and sold globally in 1980 — to the contest between Healon and its lower-viscosity, dispersive counterpart, Viscoat (4% chondroitin sulfate, 3% sodium hyaluronate, Alcon), to the development of the viscoadaptive Healon 5 (sodium hyaluronate 2.3%, Abbott Medical Optics), in which he was personally involved.
Arshinoff’s own soft-shell technique first utilized the combined properties of cohesives and dispersives before evolving into the ultimate soft-shell technique with Healon 5. The latest variation, the tri–soft-shell technique, uses a dispersive OVD to protect the corneal endothelium, a viscoadaptive OVD to form a shell for space-creation and balanced salt solution to create a low-resistance working area on the lens surface. This technique enables the management of complex cases, such as Fuchs’ dystrophy, zonulysis and intraoperative floppy iris syndrome, in safe conditions.
Recently, more companies have joined the OVD development market, because new OVDs are needed for newer techniques, such as small-incision surgery, endothelial keratoplasty and femto phaco, according to Arshinoff.
“Can we make new OVDs for these techniques? The answer is yes, because OVD properties can range from air to glass. The only constraint restricting development of new OVDs is our imagination,” Arshinoff said.
Disclosure: Arshinoff is a consultant to Alcon, AMO, Bausch+Lomb, Croma-Pharma and Anteis.