Transcript HYDROPROCEDURES

Dr. Navin Gupta M.S.
Shankar Netrika Eye Hospital,
Mumbai
HYDROPROCEDURES
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
Hydrodissectio
Advantages of Hydrodissection
 Improved maneuverability of lens
 Rotation freely in the bag
 With cortical HD - reduces the usage of I
& A hand piece
Hydrodelination
 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
Hydrodelination
 26g Blunt Cannula
 Pass into the substance of nucleus
till nucleus moves
 Create a tract by to and fro
movement of cannula
Hydrodelination
 Withdraw cannula half way
 Gentle steady pressure on plunger
 Fluid will find path of least
resistance and flows
circumferentially
 Golden ring reflex
Hydrodelination
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
Complications
 Posterior capsule rupture
 Dislocation of lens into vitreous
 Pupillary snap sign
Special situations
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No HD in mature cataract
PPC
Small pupil
Weak zonules