Here at CataractCoach, we have featured videos showing how to hydro-dissect a nucleus up, out of the capsular bag and through a relatively small pupil in order to facilitate chopping without restoring to the use of iris expansion devices. In this case, the patient has a pupil of about 4 mm and we are unable to prolapse the nucleus into the anterior chamber with hydro-dissection alone.
We can use the 27g blunt cannula to engage the nucleus and then spin or dial it up into the plane of the iris. The pupil will then hold the nucleus while we chop it into halves and then phaco-aspirate it. When the pupil holds the nucleus, it also provides stretch to the tissue so that the pupil stays expanded during cortex removal and IOL insertion. This technique is not difficult to learn and can be helpful in similar cases in the future.
Click below to learn this technique of bringing the nucleus up into the iris plane: