PHACOEMULSIFICATION WITHOUT HYDRODISSECTION – A STUDY OF 3212 CASES

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Presentation transcript:

PHACOEMULSIFICATION WITHOUT HYDRODISSECTION – A STUDY OF 3212 CASES No financial interest DR NARAYAN BARDOLOI

Hydrodissection is not necessary in modern phacoemulsification surgery DR ROBERT FROST INVENTED HYDRODISSECTION IN 1985 2010 IS THE SILVER JUBILEE YEAR OF HYDRODISSECTION 2011 DECLARES END OF HYDRODISSECTION TWO PROCLAMATIONS Hydrodissection is not necessary in modern phacoemulsification surgery Phaco without hydroprocedure is easy , safe and quick procedure EVIDENCES 3212 consecutive Microincisional coaxial phaco without hydro procedure was done at Chandra Prabha Eye Hospital , Jorhat, Assam,India, since Dec 2008 –August 2010 Only 12 cases of PCR.

WHY WE DO THIS PROCEDURE? NO SEPARATE EPINUCLEUS REMOVAL NECESSARY HOW IT IS POSSIBLE? NATURAL HYDRODISSECTION The technique creates spaces between the capsule and nuclear-epinuclear complex .The irrigating fluid makes way through these spaces to create natural hydrodissection WHY WE DO THIS PROCEDURE? Very safe & easy No hydro procedure related complication NO SEPARATE EPINUCLEUS REMOVAL NECESSARY

HOW IT IS DONE ? No change of technique , except holding the phaco tip’s bevel side way instead of usual bevel up position inside the eye. Topical Paracaine drop (No intracamerals) Temporal 2.2mm limbal incision. Usual capsulorhexis Five simple steps : SHAVING, CRACKING OF THE NUCLEUS, CHOPPING AT 4 & 7O’CLOCK POSITION,MOBILISATION OF PIECES

SHAVING WITHIN RHEXIS AREA Using 400 mm vacuum the phaco tip grasps the superficial cortex within the rhexis area. This results in formation of clefts through which irrigation fluid makes way to do natural hydrodissection

SHAVING

CRACKING THE NUCLEUS INTO TWO HALVES The nucleus is held with requisite vacuum and then is lifted up a little. This creates spaces behind the nuclear-epinuclear complex to allow irrigating fluid to pass through. Another bout of hydrodissection takes place. The held nucleus is then cracked into two by chopping.

HOLDING, LIFTING & CRACKING

CHOPPING AT 4 & 7 O’ CLOCK POSITION The phaco tip holds the left half of the nucleus at 4o’clock position & pulls it to the centre a little. This again create spaces thus allowing ingress of irrigating fluid to fashion another hydrodissection. The held nucleus is then chopped to create a triangular piece and devoured. Similar Technique at 7 o’clock of the right half nucleus produces similar effect.

CHOPPING AT 4 & 7 O’ CLOCK POSITION

MOBILITSATION OF THE REST FRAGMENTS The phaco tip & the chopper are now placed at the junction of already cracked lower halves of the nucleus. The two instruments pulls apart the two halves to fashion easy mobilization. The mobilized pieces are then devoured one by one.

FRAGMENTS MOBILIZED & DEVOURED