2 OVDs better than 1 in intumescent cataracts

This article imparts core knowledge on OVD use in intumescent cataract surgery, showing that using 2 OVDs with different viscosities can decrease complications and improve outcomes.

After staining the capsule with Trypan blue, the authors made a central indentation in the anterior lens capsule using only a medium-viscosity OVD (Healon 1.0%) in 22 patients, while a second group of 22 patients received an additional high-viscosity (2.3%) OVD to reduce capsule tension.

Using the additional high-viscosity OVD allowed for a more precise capsule opening with a diameter closer to the target diameter and reduced the risk for capsule tear.  In the single OVD group, 12 eyes deviated from the target continuous curvilinear capsulorhexis diameter (10 oversized, 2 undersized), compared with 6 eyes in the 2-OVD group (4 oversized, 2 undersized). No eye in the 2-OVD group experienced capsule tear during surgery, while a tear occurred in 2 eyes in the single OVD group, 1 of which had to be converted to extracapsular cataract extraction with anterior vitrectomy. 

The authors conclude that placing the high-viscosity OVD centrally led to safe indentation of the anterior lens capsule, which resulted in a more controlled procedure and made it easier to circle the capsulorhexis, minimizing the risk for uncontrolled extension to the periphery. It also better protected against the egress of liquefied lens material, allowing better visualization and significantly minimizing capsular bag complications.