The technique of corneal stromal hydration to help seal a phaco incision is useful to ensure a watertight incision and reduce the risk of endophthalmitis. However, corneal stromal hydration is not a fix-all for a poorly constructed incision. Any excessively leaky incision will likely require sutures for adequate closure.
The stromal hydration should be done using a 27g blunt cannula and a 3 cc syringe filled with balanced salt solution. We must remember to properly hold the hub of the cannula using this technique to avoid iatrogenic damage to the delicate ocular structures. The amount of hydration is mild and should be performed across the width of the incision, with care taken to stay away from Descemet’s layer to avoid inadvertent dissection. The angle of the cannula will also determine how much of the balanced salt solution gets into the anterior chamber so that we can also fill the eye and pressurize it at the same time.
The method of overly hydrating the lateral walls of the incision with large areas of edema, is less effective and comes with the downside of inducing significant astigmatism for a prolonged period after the cataract surgery. This technique should be avoided. There are other successful techniques such as the pre-pocket method and the Wong way which can help provide an effective seal.
click below to learn the differences in these techniques of sealing corneal incisions: