Pain perceptions during cataract surgery

Key Points

In my view intraoperative OVDs are of importance by creating space (e.g. sections of the anterior chamber, sections of the capsular bag) and by protecting the corneal endothelium. They offer additional protection, as they also save cells from damage incurred by friction caused by surgical instruments. Furthermore, intraoperative trauma due to irrigation/aspiration flow or swirling fragments of the lens nucleus in the anterior chamber is minimized. In modern cataract surgery they are used as a coating agent and for protection of the intraocular lens (IOL) during injection and implantation. There are currently numerous OVDs commercially available.

So how do you choose your OVD?

The property of a specific viscoelastic is defined by either its ability to hold together and to move as one cohesive mass or, on the contrary, by its ability, despite possible turbulences, to remain dispersive in the anterior chamber.

The ophthalmic surgeon can choose between numerous viscoelastics: OVDs based on hyaluronic acid (e.g. Healon, Amvisc Plus, Provisc), methyl cellulose (Adatocel) and chondroitin sulfate-hyaluronic acid combinations (Viscoat).

Compared to hyaluronates, methyl cellulose-containing OVDs adhere generally better to the endothelium, but are more difficult to remove, for example, by suction. Compared to hyaluronates, methyl cellulose-containing OVDs adhere generally better to the endothelium, but are more difficult to remove, for example, by suction.

Our study

The aim of our study was to prospectively evaluate pain perception during cataract surgery under topical anaesthesia and intracameral use of a lidocaine loaded ophthalmic viscoelastic device or the same OVD without lidocaine. Further evaluation (safety study) includes corneal endothelial cell count as a safety parameter.