Many decades ago when phacoemulsification was first presented to the world by Charles Kelman MD, no viscoelastic was used during the procedure because it had not yet been developed. In addition, ultrasonic energy at the time was on or off, without the ability to titrate the degree or even the pulse/burst delivery methods. The result was a relatively high incidence of post-operative pseudophakic bullous keratopathy (PBK). Visco-elastics (also called OVD: ophthalmic visco-surgical devices so they fall under the device regulations instead of drug regulations) helped to provide space and protect the corneal endothelium.
If you need a good review of the basics of visco-elastics, that can be found here. This graph below gives a general breakdown of the spectrum of OVDs.
For today’s video, the first question is: can you do phaco surgery without using any visco-elastic? And the answer is yes, as shown by our guest surgeon. But the more important questions is: for your future cataract surgery, do you want the surgeon to use visco-elastics? My commentary will serve as a primer for the young surgeon who will one day do my cataract surgery!