Amvisc plus

Manufactured by Bausch & Lomb

Sourced in United States

Amvisc Plus is a sterile, viscoelastic solution used in ophthalmic surgical procedures. It is designed to maintain the shape of the eye and protect delicate ocular structures during surgery.

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Lab products found in correlation

Calcein am, by Thermo Fisher Scientific (2 mentions) Viscoat, by Alcon (2 mentions) Model mt5000 ifr ccd, by AmScope (1 mentions) Combivisc, by Zeiss (1 mentions) Provisc, by Alcon (1 mentions) Discovisc, by Alcon (1 mentions) Duovisc, by Alcon (1 mentions)

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Amvisc (5 citations)

7 protocols using amvisc plus

CO2 Laser-Assisted CLASS Surgery Technique

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All surgeries were performed by the same surgeon (Z.S.) under retrobulbar anaesthesia (1:1 mixture of bupivacaine 0.5% and lidocaine 2%). CLASS surgeries were carried out according to the standard technique, without using antimetabolite.9 (link),10 (link) A peritomy with removal of the Tenon capsule and a careful cauterization was carried out in the superior quadrant. A 4x4 mm half-thickness scleral flap was dissected manually at the 12-o’clock position and a scleral pond was created with OT-135 CO2 laser device (IOPtiMate; IOPtima Ltd, Ramat Gan, Israel) using 20W laser energy. CO2 laser beam was then focused at the surgical limbal area, and thus, with the dissection of Schlemm’s canal and the trabeculum a 3mm wide trabeculo-Descemet window was created. A well functioning window was hallmarked by fluid percolation from the anterior chamber. A high viscosity viscosurgical device (Amvisc Plus, Bausch+Lomb, USA) was injected into the scleral bed, and then the sclera and conjunctiva were closed with 8/0 Vicryl sutures. Patients were administered Tobramycin+Dexamethason drops 4 times daily for 1 month.

Sohajda Z., Széll N., Revák Á., Papp J, & Tóth-Molnár E. (2020). Retinal Nerve Fibre Layer Thickness Change After CO2 Laser-Assisted Deep Sclerectomy Surgery. Clinical Ophthalmology (Auckland, N.Z.), 14, 1749-1757.

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Femtosecond Laser-Assisted Cataract Surgery

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IOL power was chosen to target emmetropia ±0.5 D. Every patient accepted the standard surgical procedure. In the Femto group, disposable interface contact lenses with suction rings (SoftFit Patient Interface, Alcon LenSx, Inc.) were used for the corneal applanation. LenSx software (v. 2.23, Alcon LenSx, Inc.) was used to create a 5.0 mm capsulotomy, and nuclear prefragmentation was performed to obtain 6 pieces in a cross pattern. In the Phaco group, anterior capsules were treated conventionally (Amvisc Plus, Bausch & Lomb, Inc.). Capsule forceps were used to complete a 5.0 mm continuous curvilinear capsulorhexis.
In both groups, a 2.0 mm single-plane main incision and a 0.8 mm side-port corneal incision were made with a keratome. Phacoemulsification was performed using a standard stop-and-chop technique with the longitudinal phacoemulsification system (Stellaris, Bausch & Lomb, Inc.). After the IOL implantation, the ophthalmic viscosurgical device material was removed from the anterior chamber and the capsular bag by irrigation/aspiration. All incisions were left sutureless. All patients received standard regimen consisting of topical dexamethasone tobramycin 4 times a day for 2 weeks and pranoprofen for 1 month postoperatively.

Xu J., Li W., Xu Z., Zhao B., Zhong Y., Wang K., Liu X., Song X., Yu Y., Zhu Y., Tang Q, & Yao K. (2022). Comparative visual outcomes of EDOF intraocular lens with FLACS vs conventional phacoemulsification. Journal of Cataract and Refractive Surgery, 49(1), 55-61.

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DMEK Graft Handling and Shipping

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The remaining anterior cornea was used to carry the separated 8.0 mm DMEK graft and was transferred to a glass petri dish containing storage medium, either Optisol-GS or Life4C. The storage medium preferred by the eye bank was transitioning from Optisol-GS to Life4C through the study. However, all paired grafts were stored in identical solution so that no difference existed in storage medium between groups, minimising impact on our analysis. The graft was encouraged to scroll and float. At this point, the anterior cornea was removed without direct instrument to graft contact. Once the graft had sufficiently scrolled, it was aspirated into a modified Jones Tube filled with fresh, cold storage medium. This configuration is shown in figure 1A.
The 10 grafts were shipped from RMLEB using FedEx under routine transplant tissue shipping cool conditions, packaged with water ice. After arriving at their destination on the East Coast of the USA at the 48-hour mark, fresh ice was added to the packaging and the grafts were shipped back to their original location for an additional 48 hours. After shipping, the grafts were ejected onto a bed of Calcein-AM (Invitrogen, Thermo Fisher Scientific, Waltham, Massachusetts, USA) and Amvisc Plus (Bausch+Lomb, Rochester, New York, USA) and unfolded without direct contact via the use of viscoelastic.

Chen C., Solar S.J., Lohmeier J., Terrin S., Baliga S., Wiener B.G., Lewis D.S., Chiang E., Barnes K.A., Chaurasia A, & Eghrari A.O. (2021). Viability of preloaded Descemet membrane endothelial keratoplasty grafts with 96-hour shipment. BMJ Open Ophthalmology, 6(1), e000679.

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Viability Assessment of DMEK Grafts

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Once transferred, fluorescence staining was performed with a solution of Calcein-AM (Invitrogen, Thermo Fisher Scientific) for cell viability. Amvisc Plus (Bausch & Lomb, Rochester, NY) was used to protect the cells and unscroll the graft without direct instrument manipulation for viability assessment and imaging.¹⁰ Cell loss assessment was performed using the same solutions and techniques between both transfer methods. After approximately 20 - 40 minutes of Calcein-AM exposure, the entire graft endothelium was imaged. Several images over the entire graft area were captured through a Leica DMIL inverted fluorescence microscope using an attached Amscope model MT5000(IFR) CCD. Images from each graft were stitched into one complete whole image using Adobe Photoshop. The whole image was then analyzed using Fiji ImageJ^{11 (link)} with trainable segmentation by an individual not involved with the DMEK graft preparations.

Lohmeier J., Christy J., Chiang E., Barnes K., Cai S., Chen C., Subramanya A., Chaurasia A., Rosen A., Vora P., Durr N.J., Allen R, & Eghrari A.O. (2018). Viability of Descemet membrane endothelial keratoplasty grafts folded in the eye bank. Cornea, 37(11), 1474-1477.

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DMEK Graft Preparation and Shipping

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The residual anterior donor cornea was used as a carrier for the separated 8.0mm DMEK graft and was transferred to a glass petri dish containing Optisol-GS. The graft was gently encouraged to scroll and float and the anterior cornea was removed from under the prepared graft without direct instrument to graft contact. When adequate graft scroll was achieved the graft was aspirated into a Modified Jones Tube containing Optisol-GS.
A subset of 10 grafts were tested for ECL immediately following loading. The graft was immediately ejected from the Modified Jones Tube into a bed of Calcein-AM and Amvisc Plus (Bausch & Lomb, Rochester, NY) and unfolded without direct contact using viscoelastic. The second subset of 10 grafts in the Jones Tube were shipped using FedEx under routine transplant tissue shipping cool conditions, packaged with water ice. Following shipping, the grafts were ejected into a bed of Calcein-AM and Amvisc Plus and unfolded without direct contact using viscoelastic.

Barnes K., Chiang E., Chen C., Lohmeier J., Christy J., Chaurasia A., Rosen A., Vora P., Cai S., Subramanya A., Durr N., Allen R, & Eghrari A.O. (2019). Comparison of tri-folded and scroll-based graft viability in preloaded Descemet Membrane Endothelial Keratoplasty. Cornea, 38(3), 392-396.

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Comparative Evaluation of Ophthalmic Viscosurgical Devices

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We assessed 10 different commercially available OVDs:

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Two cohesive OVDs: ProVisc (Alcon, Fort Worth, TX), Z-Hyalin plus (Carl Zeiss Meditec AG, Jena, Germany)

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Five dispersive OVDs: Amvisc plus (Bausch & Lomb, Laval, Canada), DisCoVisc (Alcon), Healon EndoCoat (Johnson & Johnson, New Brunswick, NJ), Viscoat (Alcon), Z-Hyalcoat (Carl Zeiss Meditec AG)

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And three combination systems: Combivisc (Carl Zeiss Meditec AG), Duo-Visc (Alcon) and Twinvisc (Carl Zeiss Meditec AG).

The specific characteristics of these OVD are shown in Table 1.

Wüst M., Matten P., Nenning M, & Findl O. (2022). Thickness of the Protective Layers of Different Ophthalmic Viscosurgical Devices During Lens Surgery in a Porcine Model. Translational Vision Science & Technology, 11(2), 28.

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Surgical Techniques for Astigmatism Reduction

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All surgeries were performed by the same experienced surgeon. The cylinder power and axis were calculated using the software provided by the manufacturers and taking into account the keratometric readings measured with a topographer. Phacoemulsification was performed through a 2.2-mm clear corneal incision. The astigmatism induced by the surgeon (FP) was previously known. The lenses were introduced via a 2.2-mm incision and the surgeon induced an astigmatism of 0.1 D in the right eye (temporal incision). In the left eye, the superior incision produced an astigmatism of 0.2 D. This was taken into account when the power of the lenses to be implanted was calculated.
In any case, it was necessary to open the incision for inserting the foldable IOL with the injector. To shield the corneal endothelial cells, a dispersive viscoelastic (Viscoat; Alcon Laboratories, Inc.) was first injected into the anterior chamber followed by another cohesive viscoelastic (Amvisc Plus; Bausch & Lomb) injected below the first one. The incision was not sutured and the eyes were not patched.

Garzón N., Poyales F., de Zárate B.O., Ruiz-García J.L, & Quiroga J.A. (2015). Evaluation of rotation and visual outcomes after implantation of monofocal and multifocal toric intraocular lenses. Journal of refractive surgery (Thorofare, N.J. : 1995), 31(2).

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