Cortical-cleaving hydrodissection is recognized as an important surgical step for adult cataract surgery. Several authorities have advocated various forms of interlenticular injection of fluid in adult cataract surgery.¹,²,³,⁴,⁵,⁶ Faust coined the term hydrodissection in 1984.¹ He described it as an injection of fluid designed to separate the lens nucleus from the cortex. In 1992, Fine² published his classic description of the “cortical-cleaving hydrodissection” technique. This highly effective procedure enhances the separation of the capsule from the cortex and is widely accepted as a routine surgical step for adult cataract surgery.

Pediatric cataract surgeons have been less inclined, however, to follow the adult trend for hydrodissection. Hydrodissection is barely mentioned or is glossed over in the management of pediatric cataract surgery. As the main function of hydrodissection is to release the nucleus to facilitate phacoemulsification, which is not usually an issue for pediatric cataract surgeons, the value of hydrodissection in pediatric cataract surgery has been questioned. Since pre-existing posterior capsule defects or weaknesses occur commonly in pediatric cataract patients, the fear of disrupting an already incompetent posterior capsule has made some pediatric surgeons reluctant to use the technique at all.

Numerous advantages of cortical-cleaving hydrodissection (e.g., ease, safety, and efficacy of nuclear emul-sification of adult cataracts) are well established in the literature.⁶ Apple et al.⁵ reported that the major advantage of hydrodissection lies in the shearing effect of the fluid wave. Direct injection of fluid under the anterior capsule is particularly useful in helping to remove equatorial lens epithelial cells, thereby reducing the incidence of posterior capsule opacification (PCO). When surgeons leave cortical material, which clinically resembles a strand of fiber, they actually leave large numbers of mitotically active cells from the equatorial lens bow. These cells have the potential to grow across the visual axis, especially the pearl form. The best means of reducing the incidence of this complication is to remove as many of these cells as possible at the outset. Since PCO is one of the most frequent and severe complications in pediatric cataract surgery, reports that hydrodissection may decrease the incidence of PCO prompted us to apply this inexpensive, practical, immediately implementable procedure to pediatric cataract surgery.⁷