April 26, 2025
1 min learn
Key takeaways:
- Hydrodissection is a fast however essential step in cataract surgical procedure.
- Surgeons shouldn’t hydrodissect by the facet port.
LOS ANGELES — Hydrodissection stays an essential method for cataract surgeons, in keeping with a speaker on the American Society of Cataract and Refractive Surgical procedure assembly.
Ronald Yeoh, MD, who delivered the Cornelius D. Binkhorst, MD, Lecture, mentioned he has had a “30-year love affair” with hydrodissection.
Picture: Eamon N. Dreisbach
“Hydrodissection isn’t glamorous, it isn’t attractive, but it surely’s one thing that all of us do nearly every day at any time when we do cataract surgical procedure,” he mentioned.
The step takes solely about 10 seconds, Yeoh mentioned, “but it surely’s significance, I believe, is definitely disproportionate to the period of time taken for the process and likewise the variety of phrases really written about it within the textbooks.”
Yeoh mentioned he realized an essential lesson about hydrodissection early in his profession: Don’t hydrodissect by the facet port. He mentioned this will result in hydrorupture, signified by pupil snap signal, by which the pupil abruptly constricts with a snap when the fluid bolus breaks by the posterior capsule and the nucleus sags again. Though pupil snap can happen when hydrodissecting by the primary port, Yeoh mentioned going by the facet port creates greater strain.
If pupil snap signal happens, Yeoh mentioned the surgeon can use any needle to carry the nucleus again into the anterior chamber.
“That is referred to as posterior assisted levitation, one thing that David Chang taught us a few years in the past,” he mentioned. “If you get that lens to the entrance of the attention, then you may safe it, filter the gel after which put a lens into the sulcus.”
Whereas surgeons are advised to search for a fluid wave to make sure enough hydrodissection, it can’t at all times be seen, Yeoh mentioned. As a substitute, he mentioned on the lookout for the nucleus to come back ahead or carry is usually a extra helpful signal. Surgeons can even search for capsulorrhexis or pupil enlargement, overlying cortex splitting or a “push-back” signal with a pop.
Yeoh mentioned hydrodissection continues to be essential due to extra problems seen from lens contact or needle-stick cataracts attributable to intravitreal injections and posterior capsular tears attributable to YAG laser vitreolysis.
“In these 30 years, I believe we’ve come full circle and that hydrodissection right this moment is as related because it was 30 years in the past,” he mentioned.
Sources/Disclosures
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Yeoh R. The fiftieth ASCRS Binkhorst Lecture 2025: ‘Hydro chronicles.’ Offered at: American Society of Cataract and Refractive Surgical procedure assembly; April 25-28, 2025; Los Angeles.
Disclosures:
Yeoh reviews having monetary disclosures for Alcon, Johnson & Johnson Imaginative and prescient, Rayner and Zeiss.
