The safety and efficacy of phaco-sleeve irrigation-assisted hydrodissection during femtosecond laser-assisted cataract surgery

Yoichiro Masuda,1 Hisaharu Iwaki,2 Akira Watanabe,3 Akiko Takada,3 Toshinori Okamoto,4 Kotaro Oki,5 Tadashi Nakano,3 Hiroshi Tsuneoka3 1Department of Ophthalmology, The Jikei University, Katsushika Medical Center, Tokyo, Japan; 2Iwaki Eye Clinic, Tokyo, Japan; 3Department of Ophthalmology, The Jikei University, School of Medicine, Tokyo, Japan; 4Nakamurabashi Eye Clinic, Tokyo, Japan; 5Oki Eye Surgery Center, Tokyo, Japan Abstract: Femtosecond laser-assisted cataract surgery (FLACS) changes the intraoperative environment due to the generation of intracapsular gas that induces a high intracapsular volume. Manual hydrodissection (mH) may induce high intracapsular pressure (ICP) and additional intracapsular volume, thereby leading to capsular block syndrome (CBS). Since the phaco-sleeve irrigation-assisted hydrodissection (iH) technique is used to initially groove and split the lens and remove the intracapsular gas, this can reduce the intracapsular volume while bypassing the intracapsular lens prior to the hydrodissection. As iH uses the phaco tip to intentionally vacuum the intraocular fluid for use in inducing the irrigation jet from the sleeve side holes, the ICP cannot surpass the set irrigation pressure, thereby avoiding CBS. Using this technique, we performed FLACS without CBS in 310 cataract eyes. Our findings suggest that the iH technique may be beneficial for patients by preventing CBS during FLACS. Keywords: FLACS, irrigation dynamic pressure, hydrodissection-related complication, capsular block syndrome, CBS, low invasive cataract surgery