Effect of hydrodissection alone and hydrodissection combined with rotation on lens epithelial cells Surgical approach for the prevention of posterior capsule opacification Abhay R. Vasavada, MS, FRCS, Shetal M. Raj, DO, MS, Kaid Johar, MPhil, PhD, Mayank A. Nanavaty, DO PURPOSE: To evaluate the impact of corticocleaving hydrodissection alone and hydrodissection com- bined with rotation on lens epithelial cells (LECs) and residual cortical fibers (RCFs). SETTING: Iladevi Cataract and IOL Research Center, Ahmedabad, India. METHODS: An experimental laboratory study of 20 fresh human cadaver eyes (10 pairs) was con- ducted. A single eye from each pair was assigned to the control group, in which no hydrodissection and no rotation were performed (control). The other eye was randomized to corticocleaving hydrodissection alone (Group 1) or corticocleaving hydrodissection with rotation (Group 2). Cataract extraction was standardized. Capsule polishing was omitted. Area of LEC loss (%) in the preequatorial zone (PZ) and equatorial zone (EZ) was calculated as: [Area of capsule without cells/Total area of cap- sule] Â 100. Area of presence of RCFs (%) was calculated as: [Circumference of EZ of capsule with RCF/ Total circumference of EZ of the capsule] Â 100. The Mann-Whitney U and the Wilcoxon signed rank tests were applied. RESULTS: In the control group, area of cell loss (%) was 3.9 G 3.2 in the PZ and 2.7 G 0.8 in the EZ; presence of RCFs (%) was 83.8 G 1.7. Area of LEC loss (%) in Groups 1 and 2 was 24.8 G 4.5 and 42.6 G 5.4 (P Z .008) in the PZ and 22.4 G 2.1 and 54 G 2.5 (P Z .008) in the EZ, respectively. Area of presence of RCFs (%) in Groups 1 and 2 was 34.2 G 3.7 and 23.7 G 3.7 (P Z .008), respectively. CONCLUSION: Corticocleaving hydrodissection combined with rotation removed significant quanti- ties of LECs and RCFs. J Cataract Refract Surg 2006; 32:145–150 Q 2006 ASCRS and ESCRS Hydrodissection is an important step in small-incision cata- ract surgery using phacoemulsification. Faust 1 coined the term hydrodissection in 1984. Apple et al., in a study of human cadaver eyes, investigated the technique of subcapsular fluid injection in a laboratory setting (D.J. Apple, et al., ‘‘Technique of Posterior Chamber Intraocular Lens Implantation Using a Small Smooth Circular Continuous Tear Capsulotomy- Capsulorhexis: a Demonstration Using the Posterior Video Technique in Human Cadaver Eyes,’’ video presented at the annual meeting of the American Academy of Ophthalmology, New Orleans, Louisiana, USA, October 1989). In 1992, Fine 2 provided the first and definitive description of effective sub- capsular hydrodissection in a clinical setting, thereby introducing the technique he termed cortical cleaving hy- drodissection. According to this technique, when fluid is in- jected directly under the anterior capsule, it causes a visible fluid wave that passes around the equator, traversing farther between the posterior capsule and posterior cortex. 2,3 This cause cleavage between the lens capsule and the cortex. Today, hydrodissection is accepted as an important surgical tool for adult cataract surgery 1–6 and pediatric surgery. 7 In a cadaver eye study, direct injection of fluid Q 2006 ASCRS and ESCRS Published by Elsevier Inc. 0886-3350/06/$-see front matter doi:10.1016/j.jcrs.2005.11.027 145 J CATARACT REFRACT SURG - VOL 32, JANUARY 2006