There is a consensus among ophthalmologists regarding the necessity of adequate hydrodissection prior to nucleus disassembly and emulsification. For phaco-chop and divide-and-conquer techniques, the lens must be completely mobilized to allow easy nucleus rotation. Hydrodissection should result in a fluid wave travelling completely across the posterior surface of the lens. This ensures that complete dissection of the lens from the posterior capsule has occurred. Hydrodissection cannulas of various designs are used to accomplish the dissection.
I have noticed that many colleagues do not intentionally separate the lens from the anterior capsule. If these connections are not adequately separated, the lens will be unable to rotate. In this article, I describe my method for dissecting anterior capsular connections. Residents in our clinic learn this method without significant difficulty. This is a simple and logical technique that many surgeons may already practice.
TECHNIQUE
After a complete posterior fluid wave crosses the entire posterior surface of the lens (Figure 1), depress the nucleus, which will subsequently separate itself from the anterior capsule at approximately the 4- or 5-o'clock position (Figure 2). As you press on the nucleus, fluid underneath the nucleus will shift to the opposite side. Next, depress the nucleus on the opposite side (Figure 3). The nucleus can move a little posteriorly into the accumulated fluidpool, separating itself further from the anterior capsule. Ifthe anterior capsule remains in position when the nucleusis pressed downward close to the anterior capsulorrhexisedge (Figure 4), this means that the anterior capsule and lens have separated. If one observes this separation atopposite sides of the lens, the anterior connectionsshould be sufficiently dissected to allow easy rotation.
For a full video of this procedure, please visithttp://eyetube.net/v.asp?defipe.
Khiun F. Tjia, MD, is an Anterior SegmentSpecialist at the Isala Clinics, Zwolle,Netherlands. Dr. Tjia states that he is a consultantto Alcon Laboratories, Inc. He is the Co-Chief Medical Editor of CRST Europe. Dr. Tjiamay be reached at e-mail: kftjia@planet.nl.
