Hydroprocedures Adequate 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.

Hydrodissection Three 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.

Hydrodissection Rotation 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.

Hydrodissection In 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

Hydrodelineation The 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.

Hydrodelineation Since 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.