Do you need to perform hydrodissection?

Transcription

1 Hydrodissection in Femtoassisted cataract surgery The Why and the How no financial interest DrIan YEO Singapore National Eye Centre Do you need to perform hydrodissection? 1

2 Hydrodissectionin traditional phacoemulsification Hydrodissectionof the nucleus in cataract surgery has traditionally been perceived as the injection of fluid into the cortical layer of the lens under the lens capsule to separate the lens nucleus from the cortexand capsule With increased use of continuous curvilinear capsulorrhexisand phacoemulsification in cataract surgery, hydrodissectionbecame a very important step to mobilize the nucleus within the capsule for disassembly and removal Faust KJ. Hydrodissectionof soft nuclei. Am Intraocular Implant Soc J. 1984;10: Davison JA. Bimodal capsular bag phacoemulsification: a serial cutting and suction ultrasonic nuclear dissection technique. J Cataract Refract Surg. 1989;15: Sheperd JR. In situ fracture. J Cataract Refract Surg. 1990;16: Gimbel HV. Divide and conquer nucleofractisphacoemulsification: development and variations. J Cataract Refract Surg. 1991;17: Fine IH. The chip and flip phacoemulsification technique. J Cataract Refract Surg. 1991;17: Do you perform hydrodissection with your femto cataract surgery? YES NO MAYBE 2

3 Are there any differences in the capsulorhexisperformed by the femtolaser? CapsulorhexisEdge Architecture Ophthalmology.2014 Mar 25. Abellet al.: Anterior CapsulotomyIntegrity afterfemtosecondlaser-assistedcataract Surgery (Ophthalmology 2014;121:17-24). 3

4 CapsulorhexisEdge Architecture Patient movement Laser Algorithms Ophthalmology.2014 Mar 25. Abellet al.: Anterior CapsulotomyIntegrity afterfemtosecondlaser-assistedcataract Surgery (Ophthalmology 2014;121:17-24). CapsulorhexisEdge Architecture Laser Power and Edge Smoothness J Cataract Refract Surg Oct;39(10): Scanning electron microscopy evaluation of capsulorhexis in femtosecond laser-assisted cataract surgery. Mastropasqua L1, Toto L, Calienno R, Mattei PA, Mastropasqua A, Vecchiarino L, Di Iorio D. 4

5 Femto CCC Complete CCC Potential Weakness Risk of Rip and Extention Hydrodissection Nucleus manipulation Irrigation aspiration Lens Insertion 5

6 Techniques of Hydrodissection Hydrodissection in Femtocataract Surgery Modified Conventional Hydrodissection Hydrodissectionis slightly modified to allow the release of gas bubblestrapped behind the lens. Failure to release these trapped gas bubbles has been reported to cause posterior capsular rupture in rare cases. Yeoh R. Hydroruptureof the posterior capsule in femtosecondlasercataract surgery. J Cataract Refract Surg. 2012;38: 730; author reply 730. Roberts TV, Sutton G, Lawless MA, Jindal-Bali S, Sutton G. Capsular block syndrome associated with femtosecond laser-assisted cataract surgery. J Cataract Refract Surg. 2011;37:

7 Modified Conventional Hydrodissection Technique of Releasing Gas Gently tapping on the lens or tilting it slightly with the hydrodissection cannula brings the bubbles forward quickly to allow them to escape. Using a prechopper or blunt-tipped side-port instrument with the phacotip to split the laser-cut nuclear segments to allow the gas to come forward. VIDEO 1 Modified Conventional Hydrodissection 7

8 VIDEO 2 Modified Conventional Hydrodissection WHY MUST YOU RELEASE YOUR GAS ANIMATION from Translenticular Hydrodissection in Femtosecond Laser Cataract Surgery Sheraz M. Daya; Marcela Espinosa, Centre for Sight, UK 8

9 VIDEO Translenticular Method of Hydrodissection/delineation ANIMATION and Video from Translenticular Hydrodissection in Femtosecond Laser Cataract Surgery Sheraz M. Daya; Marcela Espinosa, Centre for Sight, UK Potential Complications 9

10 COMPLICATIONS Capsular Block Posterior Capsular Rupture Capsular Rips Dropped Nucleus Good Luck and Remember to Release your gas 10

11 THANK YOU A Presentation by Singapore National Eye Centre 11