Randomized, clinical trial of multiquadrant hydrodissection in pediatric cataract surgery

Abstract

Purpose: Evaluate efficacy of multiquadrant cortical-cleaving hydrodissection in pediatric cataract surgery.

Design: Randomized multicenter clinical trial.

Methods: Surgery performed at Iladevi Cataract & IOL Research Center (57 eyes, 42 patients) and Postgraduate Institute of Medical Education and Research (23 eyes, 17 patients). Study population comprised 59 consecutive patients (80 eyes) 12 years old and younger undergoing cataract aspiration. The intervention procedure involving envelope randomization was used to assign patients to multiquadrant cortical-cleaving hydrodissection (HY) (40 eyes), or no hydrodissection (HN) (40 eyes). The main outcome measures were as follows: (1) lens-substance removal time and volume of fluid used and (2) ease of lens substance removal. Presence or absence of residual fibers on the posterior capsule was recorded.

Results: The mean +/- standard deviation lens substance removal time was significantly less in the HY group (156.1 +/- 86.8 seconds) than in HN group (210.7 +/- 73.8 seconds; P =.003). Fluid used for lens substance removal was significantly less in the HY (91.0 +/- 47.5 ml) than in the HN group (156.9 +/- 87.2 ml; P <.001). In the HY group, lens substance removal was ranked as easy in 36 eyes (90.0%), average in 2 eyes (5.0%), and difficult in 2 eyes (5.0%). In the HN group, removal was easy in 19 eyes (47.5%), average in 12 eyes (30.0%), difficult in 5 eyes (12.5%), and very difficult in 4 (10.0%) eyes (P =.0005). Residual cortical fibers on the posterior capsule were noted in 12.5% of the HY group and 22.5% of HN group, but the difference was not statistically significant (P =.2).

Conclusions: Multiquadrant cortical-cleaving hydrodissection decreases lens substance removal time, lessens fluid volume used for lens substance removal, and facilitates lens substance removal in pediatric cataract surgery.