Shetal M. Raj, DO, MS

In cortical cleaving hydrodissection, fluid is injected directly under the anterior capsule, causing a visible fluid wave that passes around the equator of the lens, traversing between the posterior capsule and posterior cortex. This causes a cleavage between the lens capsule and the cortex.

Eyes with a posterior polar cataract are predisposed to posterior capsule dehiscence during cataract surgery. In such eyes, the recommended surgical strategy is to avoid cortical cleaving hydrodissection. Instead, conventional hydrodelineation is performed. Even with the latter, there remains a possibility of fluid being injected inadvertently in the subcapsular plane, leading to unwarranted hydrodissection.

During phacoemulsification, it is desirable to remove nuclear fragments in the posterior plane to reduce the risk of endothelial damage. However, this increases the risk of posterior capsule rupture, so many of us subconsciously bring the phaco probe anterior to the rhexis as the posterior capsule gets progressively exposed.