dr. navin gupta m.s. shankar netrika eye hospital, mumbai
TRANSCRIPT
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