When we remove the cataractous lens there is sometimes a posterior plaque that is adherent to the capsule. How do we safely and efficiently remove such a plaque without damaging the underlying posterior capsule? You may be surprised to learn that I do not have a special setting on the phaco machine for this. Instead, I use the I/A probe in the normal cortex removal mode and I depress the footpedal only about half-way and I keep the port of the I/A probe at about a 45 degree angle to the posterior capsule. I find the the “capsule polish” modes are relatively useless and I just stick with my same cortex removal mode with the adjustment being in my hands: how I hold the I/A probe and how I position the port relative to the posterior capsule.
I do not use a “capsule polish” mode on the phaco machine because I find that it does very little. Instead, I keep the same cortex removal settings on the phaco machine and I adjust the I/A probe so that the port is 45 degrees from the posterior capsule. Then I use only about 1/4 or 1/2 of the foot-pedal range to apply light suction and then the I/A tip is rubbed on the opacities to mechanically remove them.
This video demonstrates that we can completely and safely remove this posterior plaque opacity from the capsular surface in a very efficient way. The entire video, unedited, is shown below so that you can see the technique.
Click below to see the complete video of this case: