Hydration Assisted Iol Implantation Instead Of Viscoelastic Material In Cataract Surgery

Continuous irrigation maintains a stable and well-formed anterior chamber while allowing controlled IOL delivery into the capsular bag. Avoiding viscoelastic eliminates the risk of retained OVD, which is a known cause of early postoperative intraocular pressure spikes—particularly relevant in eyes with pre-existing elevated IOP or intumescent cataracts. This technique also reduces surgical time, minimizes the need for additional aspiration, and ensures a cleaner capsular bag at the conclusion of surgery. Overall, irrigation-assisted IOL implantation can contribute to improved immediate postoperative pressure control and faster visual recovery.

 Phacoemulsification was performed in linear phaco mode using a phaco-chop technique with a second instrument and chopper to mechanically fragment the cataract nucleus. Phaco power was set at 35%, with an aspiration flow rate of 35 mL/min and a vacuum level of 350 mmHg. This approach allowed effective nuclear fragmentation while maintaining good chamber stability and minimizing ultrasonic energy exposure to the corneal endothelium.

Case Presentation
51-year-old male
Visual acuity: counting fingers at 50 cm
No systemic comorbidities
Intraocular pressure: 28 mmHg
Anterior segment: white cataract
Posterior segment: no detected pathology 

Take-Home Messages

White cataracts represent a spectrum, ranging from dense to intumescent types.

Proper identification of cataract type is essential for safe surgical planning.

Needle decompression and controlled capsulorrhexis reduce the risk of radial tears in intumescent cataracts.

Mechanical nuclear fragmentation with optimized phaco settings minimizes endothelial and thermal damage.

IOL implantation under irrigation, without OVD, helps maintain chamber stability and reduces early postoperative IOP spikes.