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First Author: A.Sharma UK
Co Author(s): G. Nithyanandarajah Y. Athanasiadis B. Sharma P. Scollo A. Dorgham
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A simple and effective alternative to previously described hydration methods
Moorfields Eye Hospital NHS Trust
On completion of phacoemulsification and after the intraocular lens has been implanted, with the viscoelastic still remaining, a 30 gauge yellow needle is attached on a 1ml syringe filled with balanced salt solution (BSS). The needle is embedded into the cornea just above the main clear corneal incision and advanced parallel to the wound within the anterior lamella of the stroma of the incision tunnel, bevel pointing posteriorly (figure 1a). At that position the BSS is injected into the corneal stroma until mild diffuse whitening is observed (figure 1a). Sometimes, resistance may be felt from occlusion of the needle opening by stromal matter. In this case simply withdrawing the needle fractionally should allow the egress of fluid from the syringe into the cornea. If the needle enters too deep then it can be withdrawn slightly and advanced with a shallower approach before hydratingThe viscoelastic is then removed.
Watertight incisions in 50 consecutive cases. Ocular coherence scanning confirms anterior wound stromal hydration on first post operative day.
The technique we describe is a simple and effective alternative of the previously described hydration methods, particularly useful in cases where the risk of endophthalmitis is higher such as diabetic patients and temporal clear corneal incisions. Also, it could prove useful when a poorly constructed wound might not allow hydration to be performed with success using a cannula and hypotony could occur postoperatively. The point of insertion and track of the needle into the cornea is minute and one should not anticipate any complications related to this. Also the actual architecture of the wound is not disturbed and damage to the surrounding structures such as Descemets membrane detachment cannot occur. As the anterior lamella of the tunnel is hydrated, resulting posterior presure of the lamella seal the wound effectively even when there is relative hypotony. As the hydration is in the anterior lamella only and there is a physical barrier from the endothelial pump, hydration will last much longer. Learning curve of the technique is not expected to be significantly steep. We are now routinely using this method in all of our surgeries and we have not noticed a single case of hypotony or endophthalmitis since.