With a dense cataract, a fibrous posterior plate can develop within the lens nucleus. This makes is challenging to split the cataract into smaller pieces for fragment removal phacoemulsification. In this case, the chopper is used to cleave the nucleus into two halves, but there is incomplete separating because the chop does not propagate completely through the cataract.
We have previously demonstrated different techniques of dealing with this situation such as brining the nucleus out of the capsular bag, In this case, we place the chopper around the lens equator and make many smaller chops in order to break pieces off the dense nucleus. After breaking off many smaller pieces, the remaining lens nucleus is more manageable and the case can be successfully completed.
click below to learn how to handle this tough situation:
Hi Dr. Devgan,
I learnt a lot from this great video. I have two questions: 1) do you always hold the phaco tip with the oval opening of the tip facing downwards? I was trained to hold the tip rotated 180 degrees. Are there pros and cons to each technique? 2) the lens was standing almost vertically in the bag for some part of the phacoemulsification step. Has it ever happened that an edge of the nucleus might puncture the posterior capsule?
1. bevel down is my preferred approach for phaco chop, but I will use bevel-up for divide-and-conquer or stop-and-chop.
2. no risk of this happening