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Published byAsher Benson Modified over 9 years ago
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Dr. Navin Gupta M.S. Shankar Netrika Eye Hospital, Mumbai
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Introduction Irrigating fluid is injected through a cannula into various anatomical layers of lens First described by Bluementhal Term given by Faust
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Michael Bluementhal
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Intro Include hydrodissection and hydrodelineation Mobility of lens complex with in capsule Extended the inherent advantage of CCC in SICS & Endocapsular Phaco
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Hydrodissection Injecting fluid between anterior capsule and cortex First described by Faust for ECCE Its applicability recognized in Phaco
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Hydrodissection
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Aim Mobilize the nucleus within the capsule for disassembly and removal
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Technique Tradition Hydrodissection Injecting fluid into cortical layer Gimbel, Fine & Poley Before hydrodissection anterior flap of capsule is tented/elevated by canula Hydrofree dissection
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Technique 4 - 5mm CCC 26g Blunt Cannula Anterior capsule is elevated away from cortex Injection site near lens equator
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Technique Gentle continuous irrigation Lens bulges anteriorly Decompress the lens to break equatorial adhesions Care taken not to prolapse the nucleus Slow decompression
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Phenomenon to watch for during hydro Advancement of fluid wave Anterior movement of nucleus Stretching of CCC Shallowing of anterior chamber
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Cortical-Cleaving Hydrodissection
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Cortical cleaving hydrodissection
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Conventional hydrodissection
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Hydrodissection
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Advantages of Hydrodissection Improved maneuverability of lens Rotation freely in the bag With cortical HD - reduces the usage of I & A hand piece
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Hydrodelination Separation of outer epinuclear shell from central compact endonucleus by forceful irrigation of fluid
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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
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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
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Hydrodelination 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
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Hydrodelination 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
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Hydrodelination
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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
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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
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Challenges of Hydroprocedures Attempting in presence of PC Rent Spread nuclear fragment into vitreous Surgeons experience & confidence - hydroprocedures present no additional risk
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Complications Posterior capsule rupture Dislocation of lens into vitreous Pupillary snap sign Posterior capsule rupture Dislocation of lens into vitreous Pupillary snap sign
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Special situations No HD in mature cataract PPC Small pupil Weak zonules
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