Dr. Navin Gupta M.S. Shankar Netrika Eye Hospital, Mumbai

Dr. Navin Gupta M.S.Shankar Netrika Eye Hospital, Mumbai

Introduction

Irrigating fluid is injected through a cannula into various anatomical layers of lens

First described by Bluementhal Term given by Faust

Michael Bluementhal

Intro

Include hydrodissection and hydrodelineation

Mobility of lens complex with in capsule Extended the inherent advantage of CCC

in SICS & Endocapsular Phaco

Hydrodissection

Injecting fluid between anterior capsule and cortex

First described by Faust for ECCE Its applicability recognized in Phaco

Hydrodissection

Aim

• Mobilize the nucleus within the capsule for disassembly and removal

Technique

Tradition Hydrodissection Injecting fluid into cortical layer

Gimbel, Fine & Poley Before hydrodissection anterior flap of

capsule is tented/elevated by canula Hydrofree dissection

Technique

4 - 5mm CCC 26g Blunt Cannula Anterior capsule is elevated away from

cortex Injection site near lens equator

Technique

Gentle continuous irrigation Lens bulges anteriorly Decompress the lens to break equatorial

adhesions Care taken not to prolapse the nucleus

Slow decompression

Phenomenon to watch for during hydro Advancement of fluid wave Anterior movement of nucleus Stretching of CCC Shallowing of anterior chamber

Cortical-Cleaving Hydrodissection

Cortical cleaving hydrodissection

Cortical cleaving hydrodissection

Conventional hydrodissection

Hydrodissection

Advantages of Hydrodissection

Improved maneuverability of lens Rotation freely in the bag

With cortical HD - reduces the usage of I & A hand piece

HydrodelinationHydrodelination

Separation of outer epinuclear shell from central compact endonucleus by forceful irrigation of fluid

Separation of outer epinuclear shell from central compact endonucleus by forceful irrigation of fluid

Hydrodelination

Anis introduced basic concept Injecting fluid directly into lens matter Allows the nucleus to be cracked into

layers or softened by hydration Also referred as hydrodemarcation or

hydrodelamination

Technique of Hydrodelination

Better to do after hydrodissection Inserting cannula between hard core

nucleus and epinucleus (DMZ) Cleavage plane

superficial in hard nucleus centrally in soft nucleus

Results in golden ring

HydrodelinationHydrodelination

26g Blunt Cannula Pass into the substance of

nucleus till nucleus moves Create a tract by to and fro

movement of cannula

26g Blunt Cannula Pass into the substance of

nucleus till nucleus moves Create a tract by to and fro

movement of cannula

HydrodelinationHydrodelination

Withdraw cannula half way Gentle steady pressure on plunger Fluid will find path of least

resistance and flows circumferentially

Golden ring reflex

Withdraw cannula half way Gentle steady pressure on plunger Fluid will find path of least

resistance and flows circumferentially

Golden ring reflex

HydrodelinationHydrodelination

Advantanges of Hydrodelination

Cushion like effect of the epinucleus Minimize potential damage to PC/capsular

fornix and endothelium Shielding effect - particularly important in

cases with dense nuclei

Advantage of Hydrodelination

Reduce volume of central portion of nuclei removed by Phaco

Less deep & less periphery grooving Quadrant more early mobilised after

cracking/chopping

Challenges of Hydroprocedures

Attempting in presence of PC Rent Spread nuclear fragment into vitreous

Surgeons experience & confidence - hydroprocedures present no additional risk

ComplicationsComplications

Posterior capsule rupture Dislocation of lens into vitreous Pupillary snap sign

Posterior capsule rupture Dislocation of lens into vitreous Pupillary snap sign

Special situations

No HD in mature cataract PPC Small pupil Weak zonules