When we break up the cataract using the phaco chop technique, we can end up with smaller nuclear pieces which can get stuck at the sub-incisional area. While the temptation is to retract the phaco probe to access these pieces, this is a high risk maneuver because we can lose the infusion and allow the anterior chamber to collapse.
The fluidic inflow during phaco is from the side ports of the phaco tip sleeve, which must be inside the eye in order to keep the anterior chamber inflated. When the probe is retracted, these infusion ports can allow the infusion fluid to spill on to the ocular surface, resulting in anterior chamber shallowing and collapse. And when the outflow via the phaco tip exceeds the inflow, then we will have surge and a high risk of capsule rupture.
A better move is to use another instrument such as the chopper or spatula to bring these sub-incisional nuclear pieces to the phaco tip. Alternatively, as shown in the video here, we can use balanced salt solution on a 27g cannula to wash these nuclear pieces centrally, where they can then be easily aspirated.
Click below to learn this technique to address sub-incisional nuclear cataract pieces:
