Impact of Ophthalmic Viscosurgical Devices in Cataract Surgery

Abstract

Background: Ophthalmic viscoelastic devices (OVDs) used during small-incision cataract surgery have numerous advantages. However, OVDs have longer retention time in an eye after surgery resulting in intraocular pressure (IOP) spikes. The purpose of this study is to analyze and quantify the effect of various OVDs on both IOP and best corrected visual acuity (BCVA) by systematically reviewing the literature and performing meta-analysis.

Methods: Numerous databases from January 1, 1985, to present were systematically searched. Thirty-six (3893 subjects) of 3313 studies identified were included for analysis. Standardized mean difference (SMD) was computed, and meta-analysis was performed.

Results: A total of 3313 records were retrieved including 1114 from database search and 2199 from grey literature search. Significant increase in postoperative IOP in 1-day follow-up with Healon (SMD = 0.37, CI: [0.07, 0.67]), Viscoat (SMD = 0.29, CI: [0.13, 0.45]), Provisc (SMD = 0.46, CI: [0.17, 0.76]), and Soft Shell (SMD = 0.58, CI: [0.30, 0.86]) was computed. On the other hand, results implied a nonsignificant increase in postoperative IOP with Healon GV (SMD = 0.07, CI: [-0.28, 0.41]), Healon5 (SMD = 0.15, CI: [-0.33, 0.64]), 2% HPMC (SMD = 0.32, CI: [-0.0, 0.64]), and OcuCoat (SMD = 0.26, CI: [-0.37, 0.9]). Additionally, a nonsignificant reduction in postoperative IOP was inferred with Viscoat + Provisc (SMD = -0.28, CI: [-2.23, 1.68]).

Conclusion: Improvement in IOP was shown with Viscoat + Provisc. Additionally, IOP nonsignificant upsurge was observed with Healon GV, Healon5, 2% HPMC, and OcuCoat compared to significant upsurge with Healon, Viscoat, and Soft Shell.

Figure 1

PRISMA 2009 flow diagram (from [15]; for more information, visit http://www.prisma-statement.org).

Figure 2

IOP funnel.

Figure 3

BCVA funnel.

Figure 4

Forest plot for studies examining pre- and postoperative intraocular pressure (IOP) by 30-minute and one-hour follow-up.

Figure 5

Forest plot for studies examining pre- and postoperative intraocular pressure (IOP) by five-hour follow-up.

Figure 6

Forest plot for studies examining pre- and postoperative intraocular pressure (IOP) by six-hour follow-up and ophthalmic viscoelastic devices (OVDs).

Figure 7

Forest plot for studies examining pre- and postoperative intraocular pressure (IOP) by eight-, nine-, and 16-hour follow-up.

Figure 8

Forest plot for studies examining pre- and postoperative intraocular pressure (IOP) by 24-hour follow-up and ophthalmic viscoelastic devices (OVDs).

Figure 9

Forest plot for studies examining pre- and postoperative intraocular pressure (IOP) by 24-hour follow-up and ophthalmic viscoelastic devices (OVDs).

Figure 10

Forest plot for studies examining pre- and postoperative intraocular pressure (IOP) by 24-hour follow-up and ophthalmic viscoelastic devices (OVDs).

Figure 11

Forest plot for studies examining pre- and postoperative intraocular pressure (IOP) by two-, three-, and four-day follow-up.

Figure 12

Forest plot for studies examining pre- and postoperative intraocular pressure (IOP) by one-week follow-up and ophthalmic viscoelastic devices (OVDs).

Figure 13

Forest plot for studies examining pre- and postoperative intraocular pressure (IOP) by two-week and one-month follow-up.

Figure 14

Forest plot for studies examining pre- and postoperative intraocular pressure (IOP) by three- and six-month follow-up.

Figure 15

Forest plot for studies examining pre- and postoperative best corrected visual acuity (BCVA) by follow-up (days).

Figure 16

Forest plot for studies examining pre- and postoperative best corrected visual acuity (BCVA) follow-up (months).