2 years resident having hard time with hydrodissection and cracking of the nucleus. Any help?
Hi everyone, I’m a second-year ophthalmology resident and I started learning cataract surgery about a month ago.
I actually completed my first full cataract surgery last week, which went quite well, but I’m still having some difficulties in the cases after that.
The capsulorhexis is going well for me, as well as the other steps such as cortical aspiration and IOL implantation. The most difficult part for me at the moment is hydrodissection and especially cracking the nucleus.
With hydrodissection, I enter under the capsule, lift the edge of the rhexis slightly and inject, but I often have difficulty seeing a clear wave passing through the nucleus. I usually see small “pseudo-waves” or little waves, but rarely a clear wave that travels all the way across the nucleus.
I usually try again from the other side, at 6 and 12 o’clock, and eventually the fluid passes through, but sometimes I feel like I’m filling the space too much between the posterior capsule and the nucleus.
I’ve watched many videos from Cataract Coach and other cataract surgeons on YouTube, but despite that, my hydrodissection only works occasionally.
All my colleagues tell me that it mainly comes with experience, but since we are many residents we need to improve as much as possible with every case.
For those of you who have more experience, what do you think are the most common mistakes that make hydrodissection difficult? Do you have any practical tips for getting a good hydrodissection wave and improving nucleus cracking?
Any advice would be really appreciated. Thanks!