Passive-hydro phacoemulsification

Manual hydrodissection is a standard step in phacoemulsification to separate the cortical–capsular complex, but it may precipitate sudden intraocular pressure (IOP) fluctuations and capsular stress, especially in eyes with posterior polar cataract. Passive-Hydro Phaco is a modified phacoemulsification technique designed to eliminate hydrodissection while preserving nuclear mobility and cortical separation through irrigation-driven fluid dynamics. After capsulorhexis and clear corneal incision, the phaco tip is introduced without any manual hydrodissection. The technique involves four sequential steps: (1) shaving the superficial cortex within the capsulorhexis area to create micro-clefts allowing irrigation fluid to enter the cortical–capsular layers; (2) cracking the nucleus using vertical chop, generating additional separation space; (3) the phaco tip engages the right hemi-nucleus at the 7 o’clock position and gently draws it toward the center. (4) The engaged fragment is then chopped to create a triangular segment, which is subsequently emulsified. Similarly, the left hemi-nucleus is engaged at the 4 o’clock position, chopped, and emulsified; (5) mobilizing the remaining nuclear material 180° using a Sinskey Hook, enabling smooth rotation and emulsification without zonular traction. Throughout the procedure, the passive inflow of irrigating fluid gradually cleaves the nucleus from the lens capsule without inducing a high-pressure wave. The technique promotes natural cortical separation requiring mechanical force or fluid bolus injection through the capsulorhexis edge. Passive-Hydro Phaco offers excellent chamber stability, enhanced control in high-risk cases like posterior polar cataract, and avoids hydrodissection-related complications, while maintaining standard surgical flow and phaco energy settings.