Supracapsular phaco techniques are in closer proximity to the corneal endothelium, which can be damaged by the ultrasonic energy from the phaco probe. Generally, we like to perform phaco in or close to the capsular bag in cases of increased nuclear density such as 3 to 4+ nuclear sclerosis. We can, however, still perform a safe and efficient phaco by partially tilting the nucleus out of the capsular bag and then performing phaco chop.
This case shows a relatively dense cataract with a fibrous posterior plate. This can be a challenge to chop or crack with the typical anterior approach. With the tilt and chop technique, we are able to place the phaco probe into the anterior surface of the cataract while the chopper digs into the posterior surface of the dense nucleus. The two instruments are brought together and then apart to effectively chop the nucleus into smaller fragments.
click below to learn the specifics of this very useful phaco technique: