PHACOEMULSIFICATIONPHACOEMULSIFICATIONWITHOUT HYDRODISSECTIONWITHOUT HYDRODISSECTION

– A STUDY OF 3212 CASES– A STUDY OF 3212 CASES

No financial interestNo financial interest

DR NARAYAN BARDOLOIDR NARAYAN BARDOLOI

HYDRODISSECTION• 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.

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 ?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 AREASHAVING 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 CRACKING THE NUCLEUS INTO TWO HALVESTWO 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 CHOPPING AT 4 & 7 O’ CLOCK POSITIONPOSITION

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 MOBILITSATION OF THE REST FRAGMENTSREST 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