We have a fun case here: the patient has a long-time history of Flomax (tamsulosin) use which limits his pupil dilation and also leads to floppy iris syndrome. In the past I have used a method to bring the nucleus out of the capsular bag and into the plane of the iris. This is helpful since the iris will hold the nucleus during phaco — but in this case, that is not possible. This patient is a high hyperope with a small eye, shallower anterior chamber, and a calculated IOL power of between +26 and +27 diopters.
Our technique for this case is to chop the nucleus into two halves within the capsular bag. We will make a capsulorhexis of about 5 mm, which is larger than the pupil size of about 4 mm. Then we will use a combo chop technique to split the nucleus into two halves, each of which will then be phaco-aspirated.
Click below for phaco chop for a floppy iris syndrome cataract case: