Hidden Nuclear Fragment during Cataract Surgery

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When we break up the cataract during phaco surgery, we create many small little pieces which are then aspirated from the eye. Occasionally, there can be a retained cataract piece, either cortex or nucleus, which is not discovered until the post-operative period. We have previously discussed methods of dealing with this, but even better would be to prevent this occurrence.

In the case shown here, everything seems relatively routine all the way until IOL insertion into the capsular bag. Just prior to removing the viscoelastic at the end of the case, we notice that there is a small nuclear fragment located in the superior angle. The light colored iris along with corneal arcus senilis make the cataract fragment difficult to see. A good maneuver is to use the balanced salt solution with a 27g cannula at the end of the case to sweep the angle of the eye to remove any retained viscoelastic or cataract pieces.

Click below to see if you can determine when the cataract piece becomes hidden

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