Management of the Hemi-Nucleus in Cataract Surgery

heminucleus title

Whether you do phaco chop or stop-and-chop, you will be left with two halves of the nucleus which then need to be removed directly or sub-chopped and then removed. How we manage each hemi-nucleus is crucial in the efficiency and ease of our cataract surgery. The primary issue is being able to lift the first hemi-nucleus out of the capsular bag and into the iris plane. This large nuclear piece must be able to squeeze through the capsulorhexis first.

We can sub-chop each hemi-nucleus while it is still in the capsular bag in order to make quadrants or sextants. Each of these smaller pieces can be removed through even a somewhat smaller capsulorhexis. And once we have started to remove nuclear fragments, there is more working room within the capsular bag and that makes access to the other nuclear pieces easier.

heminucleus diagram

The key to lifting a hemi-nucleus out of the capsular bag is to bring out one corner of it first. Avoid holding the center of the hemi-nucleus with the phaco probe since this attempt to bring up the entire piece at once will be met with much resistance from the capsulorhexis. Bringing out one end of the hemi-nucleus first is the easiest.

Click below to learn how to manage a hemi-nucleus during cataract surgery:

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  1. Hi Uday
    Just a thought for a tip- I watched a Tim Root cat video with my resident yesterday and noticed that after he hydrodissected he used a Connor wand through the primary incision to spin the nucleus- I did that maneuver 6 times today and it was the best spin I had ever done- the other parts went so much easier- I’ve struggled for 20 years to get consistent good rotation and have wondered how others get it done so easily- I’ve tried Chang cannula and read about various techniques- this was a revelation! Perhaps you could show it or comment?


    Alan Margolis MD

    1. great idea — I will make a video of techniques for nucleus rotation. I simply use a 27g cannula and I can certainly achieve excellent rotation consistently. Thanks for the suggestion.

    2. Dear Sir,
      We use sinsky hook to rotate the nucleus and it gives a very good rotation in all cases post hydro.
      Regards from India

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