You’re an experienced phaco chop surgeon and you come across a case where you just cannot get the chop to propagate through the cataract. The lens nucleus is still in one piece and it is tough and fibrous and resistant to your phaco chops. What do you do now?
My approach is to slow down and plan to do many smaller chops around the circumference of the lens nucleus. Each of these chops may only be partial and may only score the nucleus instead of cleaving it. That is acceptable because once we achieve many of these smaller chops, we will eventually get a small nuclear piece to break off, and then we can proceed in removing it. This is repeated until the entire cataract is removed in small pieces.
As shown in previous videos here, we can also embed the chopper more deeply or even bring it behind the posterior surface of the cataract (Prof Milton Yogi’s special chopper).
For phaco settings, start with something similar to this:
- high vacuum, 500 mmHg or higher, to have sufficient holding power
- high flow, 50 cc/min or higher, so that the pieces come towards the phaco tip
- high infusion pressure or high bottle height to keep inflow of fluid high
- moderate ultrasound power to start in order to efficiently phaco the nuclear pieces
Click below to watch the video of this technique:
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