Minimal water-jet hydrodissection

Evolution of manual small-incision cataract surgery from 8 mm to 2 mm - A comprehensive review

Cataract is the most common cause of reversible blindness worldwide, accounting for approximately 50% of blindness worldwide. Cataract surgery is the most common surgical procedure performed in routine ophthalmic practice. It has undergone tremendous evolution, and the incision size has progressively reduced from 10-12 mm in extracapsular cataract surgery (ECCE) to 6-8 mm for manual small-incision cataract surgery (MSICS) and 2.2-2.8 mm in phacoemulsification. In a developing country like India, with a massive backlog of cataract, everyone cannot afford private surgery like phacoemulsification. Moreover, annual maintenance of the machine, cost of foldable IOLs, need for greater skill, learning curve, and difficulty in performing the surgery in mature and brown cataracts are other barriers. Due to these factors, MSICS is the surgery of choice in the developing world, with profound societal and economic benefits and similar visual recovery compared to phacoemulsification. During the last two decades, MSICS gained popularity in developing countries and has undergone tremendous advances. This article aims to review the various techniques of MSICS and how the surgery has evolved over the years, particularly focusing on the current technique of 2-mm MSICS.

Multiquadrant versus single quadrant cortical cleaving hydrodissection during phacoemulsification of age related cataract

Purpose

To evaluate and compare single and multiquadrant hydrodissection in age related cataract.

Design

Prospective, observational case series.

Methods

In this study, 220 patients were consecutively assigned to either single (n = 110) or multiquadrant (n = 110) hydrodissection during phacoemulsification. Patients having operable cataract in the nuclear grade of 1–3 of Lens Opacities Classification System III were included in the study. After hydrodissection of the nucleus nuclei were not rotated. Parameters assessed were amount of balanced salt solution (BSS) required to accomplish the hydrodissection, nucleus emulsification time (NET), and cortical aspiration time (CAT). Ease in nucleus rotation during chopping of the nucleus, cortical aspiration (easy, difficult, or very difficult) and intraoperative surgical complications were qualitatively assessed.

Results

Average amount of BSS required in multiquadrant hydrodissection was 1.7 ml (±0.9), which was more than double the single quadrant group 0.71(±0.17), p = 0.001. No statistically significant differences were observed between the two studied groups with respect to the following parameters: mean NET (single quadrant 277 sec ± 95.5, multiquadrant 267 sec ± 98.8, p = 0.379), CAT (single quadrant 75.7 sec ± 31.2, multiquadrant 73.4sec ± 33.9p = 0.301), and total fluid required (single quadrant 154 ml ± 64.9, multiquadrant 157 ml ± 66.4p = 0.708).

Almost equal number of patients in both the groups had easy rotation of the nucleus (single quadrant: n = 105, 95.45% and multiquadrant n = 103, 93.64%) and cortical aspiration (n = 102, 92.72% both the groups). Three patients in multiquadrant group had posterior capsular rupture during hydrodissection.

Conclusions

A single quadrant hydrodissection is sufficient for the efficient removal of nucleus and cortex.