Ophthalmic Viscosurgical Devices (OVDs): Cohesive, Dispersive, Viscoadaptive, Brands, Soft-Shell Technique and Removal
Last updated: November 2026
Viscoelastics (ophthalmic viscosurgical devices, OVDs) keep the anterior chamber formed, protect the endothelium and help with capsulorhexis and IOL insertion. They behave very differently depending on how cohesive or dispersive they are. Choosing the right one, and removing it properly, prevents endothelial damage and pressure spikes.
Cohesive vs dispersive
| Property | Cohesive | Dispersive |
|---|---|---|
| Molecular behaviour | Long chains that stick together | Shorter chains that spread and coat |
| Viscosity at rest | High | Lower |
| Best for | Creating and maintaining space, deepening the chamber, opening the bag for IOL insertion | Coating and protecting the endothelium; staying in place during phaco; tamponading vitreous at a small capsule tear |
| Removal | Easy: comes out in one mass | Harder: needs careful I/A, can be left behind |
| Examples | Sodium hyaluronate 1% (Healon, Provisc), 1.4% (Healon GV) | Viscoat (chondroitin sulphate + hyaluronate), HPMC 2%, Healon EndoCoat |
| Special types | Examples | Behaviour |
|---|---|---|
| Viscoadaptive | Healon5 (2.3% hyaluronate) | Very cohesive at low flow, fractures and behaves dispersively at high flow; good for small pupils and deep chambers; must be removed thoroughly |
| Viscous dispersive (combination) | DisCoVisc | Single product with intermediate behaviour |
HPMC (hydroxypropyl methylcellulose 2%) is inexpensive and widely made in India. It is dispersive-like, coats well and is common in manual SICS, but it is less space-maintaining and must be washed out thoroughly. Several Indian companies also make sodium hyaluronate OVDs in 1–1.8% strengths.
Which OVD when
| Situation | Choice |
|---|---|
| Routine phaco | Either type; dispersive gives more endothelial protection |
| Low endothelial count, Fuchs dystrophy, hard cataract | Dispersive, or the soft-shell technique |
| Shallow chamber, positive pressure, capsulorhexis running out | Higher-viscosity cohesive or viscoadaptive to flatten the capsule |
| Small pupil | Viscoadaptive or cohesive to stretch the pupil (viscomydriasis) |
| Small posterior capsule tear | Dispersive over the tear to hold back vitreous |
| IOL insertion | Cohesive to open the bag; also used to load cartridges (follow the IOL insert) |
Soft-shell technique (Arshinoff)
Steps
- Inject a dispersive OVD first to fill about 70% of the chamber.
- Inject a cohesive OVD under the dispersive, onto the anterior capsule centre.
- The cohesive pushes the dispersive up against the endothelium as a protective "shell" and flattens the capsule.
- Perform the capsulorhexis under this stable chamber.
- For IOL insertion, a variation uses BSS under the dispersive layer (ultimate soft shell).
Removing OVD
- Retained OVD causes a pressure spike on the first postoperative day, worse with high-viscosity cohesive and viscoadaptive OVDs.
- Remove from behind the IOL as well as in front (rock-and-roll or behind-the-lens technique with the I/A tip), unless the posterior capsule is torn.
- Dispersive OVD is harder to remove; spend extra time or use higher flow.
- In high-risk eyes (advanced glaucoma), check IOP after a few hours or consider pressure-lowering treatment.
Pearls
- Dispersive protects, cohesive creates space.
- Soft shell: dispersive first, then cohesive underneath.
- Always clear OVD from behind the IOL in an intact bag.
Common mistakes
- Leaving viscoadaptive or high-viscosity OVD behind (IOP spike).
- Overfilling the chamber before the rhexis and raising pressure.
- Using dispersive OVD expecting easy removal.
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Related: Phacoemulsification Step by Step: A Beginner's Guide, IOL Injectors and Cartridges for Residents: Alcon A, B, C, D, Preloaded Systems, J&J Unfolder, Zeiss, Medicel and Indian Lenses, Intracameral Drugs in Cataract Surgery: Moxifloxacin, Cefuroxime, Adrenaline, Lignocaine and Mydrane, With Dilution Safety, Cataract Pre-operative Risk Checklist: Spot the Difficult Case, Phaco Machine Settings for Beginners: Peristaltic vs Venturi, Vacuum, Flow, Power and Fixing Surge.
Key sources
- Arshinoff SA. Dispersive-cohesive viscoelastic soft shell technique. J Cataract Refract Surg. 1999;25:167-173
- Arshinoff SA, Jafari M. New classification of ophthalmic viscosurgical devices, 2005. J Cataract Refract Surg. 2005;31:2167-2171
- Bissen-Miyajima H. Ophthalmic viscosurgical devices. Curr Opin Ophthalmol. 2008;19:50-54
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