Corticocapsular cleavage during phacoemulsification: Viscodissection versus hydrodissection. Miyake-Apple view analysis.
OBJECTIVE
To compare the corticocapsular separation created by viscodissection and by hydrodissection using Miyake-Apple video-photographic analysis.


METHODS
University-based center.


METHODS
Fourteen cadaver eyes were randomized to hydrodissection (Group 1, n=7) or viscodissection (Group 2, n=7). Twelve eyes were prepared for Miyake-Apple viewing. One eye in each group was prepared to simulate a closed chamber. On Miyake-Apple viewing, corticocapsular separation was graded from 0 to 3 after hydrodissection/viscodissection and at the sculpting, nuclear division, and early and late fragment removal stages. The surgeon's subjective impression of the mechanical cushion effect was noted. Histopathology of the capsular bag was performed in 4 eyes in each group to determine the amount of residual lens epithelial cells (LECs).


RESULTS
More space was created and maintained between the capsule and cortex in Group 2 than in Group 1. The mean scores in Groups 1 and 2 were endpoint of hydrodissection/viscodissection 1.92+/-0.38 and 2.58+/-0.38, respectively (P=.05); sculpting, 1.6+/-0.42 and 2.3+/-0.45, respectively (P=.05); nuclear division, 0.9+/-0.42 and 1.5+/-0.35, respectively (P=.13); early fragment removal, 0.6+/-0.22 and 1.0+/-0, respectively (P=.04); and late fragment removal, 0.1+/-0.22 and 0.4+/-0.22, respectively (P=.17). Although only early fragment removal achieved statistical significance, the surgeon's impression confirmed greater cushion effect with viscodissection. Residual LECs in the 2 groups were comparable.


CONCLUSIONS
Viscodissection as an adjunct to hydrodissection created and maintained greater corticocapsular separation than hydrodissection alone during phacoemulsification.
John A. Moran Eye Center, , University of Utah School of Medicine, Salt Lake City, Utah, USA. vvasavada@hotmail.com
Vaishali
V
Vasavada
Viraj A
VA
Vasavada
Liliana
L
Werner
Nick
N
Mamalis
Abhay R
AR
Vasavada
Alan S
AS
Crandall
D006801:Humans; D007903:Lens Capsule, Crystalline / Q000601:surgery; D018918:Phacoemulsification / Q000379:methods*; D010781:Photography / Q000379:methods*; D014019:Tissue Donors