In this picture, the capsulorhexis appears to be on the small side, but it is actually just about perfect with a 5-mm diameter. It looks small because this patient has a cataract with a larger diameter and the pupil is widely dilated. Since we are removing cataract pieces through the capsulorhexis, we need to take into account the size of the nucleus compared to the size of the capsular opening.
Here, seeing that the nucleus is large, to facilitate removal of the hemi-nuclear pieces, we hydro-delineate the cataract. This gives us an endo-nucleus which is smaller than the full nucleus. This allows the phaco chop technique to proceed without issues.
Advanced surgeons tend to perform just hydro-dissection, and usually bypass hydro-delineation, in order to make the procedure more efficient. For novice surgeons, I recommend routinely performing both hydro-dissection and hydro-delineation in order to facilitate the procedure.
Click below to learn from this technique of hydro-delineation prior to phaco chop:
All content is © 2018 by Uday Devgan MD. All rights reserved.