In previous videos, I have shown my technique for breaking up a dense brunescent cataract with a fibrous and tough posterior nuclear plate. Those techniques have involved lifting the nucleusout of the capsular bag or tilting it to directly chop the posterior plate. In this case we will take a different approach that may be better suited to beginning or novice ophthalmic surgeons.
We use multiple small chops to break up the dense nucleus into small pieces. We break off one piece at a time then emulsify it and then we break off another piece and repeat. In total, we break the nucleus into about a dozen pieces. This allows a controlled and methodical way to attack the dense, brunescent cataract.
A few more helpful bits of advice:
- use a good quality dispersive viscoelastic to coat the corneal endothelium
- try to stay at the iris plane and away from the corneal endothelium
- re-coat the corneal endothelium periodically
- use phaco power modulations such as pulse or burst mode with a variable duty cycle to limit the ultrasonic energy placed into the eye
- float in the incision and ensure sufficient cooling of the phaco tip to avoid a phaco wound burn
- once the last nuclear piece is all that remains, be careful to place the chopper in a protective position so that the posterior capsule does not get ruptured
- these eyes may have more post-op inflammation, so aggressive treatment using topical steroids may be required
Click below for the video of this multiple small chop technique: