Consider secondary hydrodissection if primary maneuver fails

Simple technique

If the cortex is not cleaved by the primary hydrodissection, Dr. Gottsch makes a central groove, removes the phaco instrument from the eye, and performs the secondary hydrodissection.

"For some reason, once the central groove is made, the lens is able to fold up more easily on itself so that it pops out partially into the anterior chamber," Dr. Gottsch said. "It is quite impressive to see how reliable this technique is in freeing the lens from the bag, and it is also quite serendipitous how the edge that presents in the anterior chamber lies in a location that is highly accessible for further manipulation."

Overall, outcomes of the procedures involving secondary hydrodissection have been very favorable with respect to visual results and absence of intraoperative and postoperative complications, he reported.

"Although this technique necessitates chopping in the anterior chamber, I have encountered no problems with postoperative corneal edema, and because the lenses in these cases are typically soft, the phaco times are very short," Dr. Gottsch said.

Dr. Gottsch estimates that he has had to perform tertiary hydrodissection in about 1 in 50 cases where he has performed secondary hydrodissection. In that situation, he expands the groove before repeating the hydrodissection.