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While several techniques and instruments are available to remove cortex safely, the author was frustrated by the lack of consistency in standard hydrodissection. This study was undertaken to determine if a directed-flow technique could achieve more complete cortical cleavage, thus improving the efficiency of this vital step.
In placing the irrigation cannula central to, but not underneath the capsule, the anatomic plane between the capsule and cortex can be more consistently located. Initiating the flow in this fashion achieves a more complete hydrodissection wave. Two subtleties improve the reproducibility of this modification to the standard technique. The first is the initiation of flow just above the capsule, moving down until it is aimed directly at the edge of the capsulotomy. The second is to allow the nucleus to "float" under the restriction of the shaft of the cannula, rather than pressing the nucleus downward.
(Additional cases will be added to the evaluation.) At the time of submission, the original premise of directing flow toward the capsulotomy edge yields a 33% rate of complete cortical separation, with cortical removal rated as easy in 58% of evaluated cases (n=79). The two additional refinements to this technique improves complete cortical separation to 62%, with cortical removal rated as easy in 86% of studied cases (n=67). These results will be compared to a cohort of cases of standard hydrodissection by the same surgeon. The only identified weakness of the directed-flow irrigation is its lack of suitability for a pupil smaller than 4 mm.
Directed-Flow Hydrodissection improves the consistency of achieving an irrigation flow in the proper anatomic plane between the capsule and cortex. This facilitates cortical removal at the conclusion of nuclear removal, improving the efficiency of cataract surgery.