Alex Young , 2025-04-26 21:46:00
April 26, 2025
1 min read
Key takeaways:
- Hydrodissection is a quick but important step in cataract surgery.
- Surgeons should not hydrodissect through the side port.
LOS ANGELES — Hydrodissection remains an important technique for cataract surgeons, according to a speaker at the American Society of Cataract and Refractive Surgery meeting.
Ronald Yeoh, MD, who delivered the Cornelius D. Binkhorst, MD, Lecture, said he has had a “30-year love affair” with hydrodissection.
Image: Eamon N. Dreisbach
“Hydrodissection isn’t glamorous, it isn’t sexy, but it’s something that we all do almost daily whenever we do cataract surgery,” he said.
The step takes only about 10 seconds, Yeoh said, “but it’s importance, I think, is actually disproportionate to the amount of time taken for the procedure and also the number of words actually written about it in the textbooks.”
Yeoh said he learned an important lesson about hydrodissection early in his career: Do not hydrodissect through the side port. He said this can lead to hydrorupture, signified by pupil snap sign, in which the pupil abruptly constricts with a snap when the fluid bolus breaks through the posterior capsule and the nucleus sags back. Although pupil snap can occur when hydrodissecting through the main port, Yeoh said going through the side port creates higher pressure.
If pupil snap sign occurs, Yeoh said the surgeon can use any needle to lift the nucleus back into the anterior chamber.
“This is called posterior assisted levitation, something that David Chang taught us many years ago,” he said. “When you get that lens to the front of the eye, then you can secure it, clear out the gel and then put a lens into the sulcus.”
While surgeons are told to look for a fluid wave to ensure adequate hydrodissection, it cannot always be seen, Yeoh said. Instead, he said looking for the nucleus to come forward or lift can be a more useful sign. Surgeons can also look for capsulorrhexis or pupil enlargement, overlying cortex splitting or a “push-back” sign with a pop.
Yeoh said hydrodissection continues to be important because of more complications seen from lens touch or needle-stick cataracts caused by intravitreal injections and posterior capsular tears caused by YAG laser vitreolysis.
“In these 30 years, I think we’ve come full circle and that hydrodissection today is as relevant as it was 30 years ago,” he said.
Sources/Disclosures
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Yeoh R. The 50th ASCRS Binkhorst Lecture 2025: ‘Hydro chronicles.’ Presented at: American Society of Cataract and Refractive Surgery meeting; April 25-28, 2025; Los Angeles.
Disclosures:
Yeoh reports having financial disclosures for Alcon, Johnson & Johnson Vision, Rayner and Zeiss.
