We have shown videos for soft posterior subcapsular cataracts where we prolapse the entire lens out of the capsular bag and then easily emulsify and aspirate it. And we have shown videos where we recommend the phaco chop technique for a dense nuclear cataract. But what is the best approach when the patient has a cataract with both a dense posterior subcapsular plaque and a relatively dense nuclear sclerotic center?
This two-step technique allows us to separate the posterior subcapsular opacity from the capsule using hydro-dissection, then we can use hydro-delineation to separate the dense central nuclear sclerotic core. This hydro-delineation step produces the characteristic golden ring that we can see in this video.
The phaco chop technique is then used to split and remove the endo-nucleus first. Once this is complete, the epi-nuclear shell which contains the posterior plaque is aspirated using the phaco probe with just vacuum and no ultrasonic energy. The rest of the case proceeds beautifully and at the end we have a great result.
Click below to learn this two-step technique for a combined PSC and NS cataract: