During cataract surgery it is important that we remove all of the lens cortex in order to minimize post-operative inflammation as well as avoiding opacities which could occlude the visual axis. For most cases, using the co-axial irrigation/aspiration (I/A) probe is sufficient for full removal of the cortex.
The sub-incisional cortex can be the toughest to remove because of the challenging access. One helpful maneuver is to bring the eye out of primary position to better place the I/A probe in close proximity to the cortex, just be careful not to inadvertently grab the posterior capsule.
A bimanual approach to cortex removal can also solve this issue and new hand-pieces such as the Alcon Transformer I/A allow the conversion from coaxial to bimanual instantly. Dedicated bimanual I/A sets are also available but these typically require two separate paracetesis-type incisions.
In the video here we simply implant the IOL into the capsular bag and then rotate it so that the lens haptic helps loosen the cortex from the capsular equator. Then when the coaxial I/A probe is placed in the eye, the cortex is easier to remove and the IOL optic will hold the posterior capsule away and prevent damage to it.
Click below to see my quick and easy approach to stubborn sub-incisional cortex:
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