HydroproceduresAdequate Hydroprocedures are Crucial for

a Successful cataract Surgery.

Includes two steps :

Hydrodissection

Hydrodelineation

Hydrodissection

Produces a broad fluid Wave that

Separates the cortex and the capsule

HYDRODISSECTION Gentle injection of irrigating fluid is

performed to separate the peripheral cortex from the underlying capsule.

Loosening the lens nucleus /cortex complex facilitates nuclear rotation during phacoemulsification.

Cont.A bent , blunt – tipped 25 to 30 gauge needle attached to a 3CC syringe under the anterior capsular flap

While the capsular flap is gently lifted , balanced salt solution is injected to hydrodissect the posterior cortical lamellae from the capsule

Gentle irrigation should continue until the surgeon sees a wave of fluid moving across the red reflex zone

Hydrodissection technique

The fluid wave can be seen going posteriorly and after a successful hydrodissection.

Free rotation of the nucleous suggests a successful hydrodissection.

HydrodissectionThree separate goals:

Endonucleus rotation

Epinucleus rotation

Loosening of the cortex

Hydrodissection Technique

Should always be done from the main wound and never from the side ports

If the injected fluid does not find easy exit ,

The fluid wave can increase the pressure within the capsular bag to a dangerous level and lead to a dehiscence of the posterior capsule.

Hydrodissection In microincission cataract surgery,since only two side ports are made,the fluid injection must be done slowly and the anterior chamber constantly decompressed by depressing the side port incision to allow some fluid to leak out.

This prevents rise in intraocular pressure.

HydrodissectionRotation of the nucleus is the key for a safe phaco surgery ,especially in cases of cataract with corticocapsular

adhesions .

The advantage of rotation is to bring the nucleus into a comfortable chopping

zone during phacoemulsification .

HydrodissectionIn pediatric cataract surgery, multiquadrant

hydrodissection has been recommended .

This leads to a complete hydrodissection ,ensures

a capsule free from epithelial cell remnants and

has bean shown to have significantly decrease

the surgical time for lens substance

removal.PCO is also redused.

Cont.

If the nucleus is displaced into the anterior chamber it can be deposited into the capsular bag with viscoelastic and posterior pressure

Cont.Hydrodissection is riskier after a can opener capsulatomy and may result in significant radial tears that can extend posteriorly and threaten the

posterior capsular integrity

HydrodelineationThe infusion fluid is injected between the epinucleus and nucleus ,to create a posterior epinucleus which acts as a cushion safe guarding the posterior capsule during phacoemulsification.

HydrodelineationSince the nuclear size is reduced,nucleus manipulation and rotation are faciliated.

Reduced the stress on the zonules during the surgery and thereby decreases the risk of zonular dialysis and posterior dislocationof the nucleus.

Hydrodelineation Injection of balanced salt solution into the substance of the nucleus to hydrodelineate or separate the various layers of the nucleus

Hydrodelineation

Facilitated the phacoemulsification process by softening the nucleus as well as allowing a rim of cortical material to remain behind that can act as a cushion to protect the underlying posterior capsule from inadvertent trauma during nucleus removal

Hydrodelineation technique

Infusion fluid is injected into the nucleus through 26-30 gauge cannula at the edge of the capsulorhexis until it meets resistance.the point of resistance is the end point of the soft outer nucleus and beginning of the firm inner nucleus.

This cleavage is difficult to identify in very hard cataracts in the elderly .

Hydrodelineation technique

At the point of resistance,the cannula is pulled back a fraction of a millimeter and the fluid is injected.

The fluid passes into the body of the cataract and creats the cleavage plane,usually identified by the appearance of a golden ring around the inner nucleus.

Hydrodelineation

Most frequently,a circumferential golden

ring will be seen outlining the cleavage

beetween the epinucleus and the

endonucleus.

Sometimes the ring will appear as a dark

circle rather than a golden ring.