Phaco flip has an advantage over other methods of nucleus division: the cataract is already partially out of the capsular bag. This means that we are not as close to the posterior capsule and also, since we are not operating within the capsular bag, issues such as an overly deep anterior chamber in a post-vitrectomy eye are lessened. In addition, this patient uses Flomax (tamsulosin) and is predisposed to IFIS (intra-operative floppy iris syndrome), which can be largely avoided because the nucleus is holding the iris tissue in place and keeping the pupil expanded.
The key for phaco flip is a sufficiently large capsulorhexis of at least 5 mm in diameter, and even a bit larger if the nucleus is dense. We must also re-coat the corneal endothelium with dispersive viscoelastic prior to inserting the phaco probe. Using phaco power modulations to limit the ultrasonic energy is also helpful in maintaining corneal clarity in the post-op period.
Click below to watch this technique of Phaco Flip:
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