In some cataract cases it is helpful to perform hydro-delineation to separate the dense endo-nucleus from the softer epi-nucleus. Once we remove the last piece of the endo-nucleus, what is the best technique to remove the epi-nuclear shell?
Using the irrigation/aspiration probe can work, but it is slow and cumbersome due to the small size of the aspiration port. A more efficient and easier technique is to use the phaco probe to aspirate the epi-nuclear shell. You do not need a specialized phaco setting or mode to remove the epi-nucleus. Simply use your regular phaco chop settings and then depress the foot pedal to generate a modest amount of vacuum and flow, but without engaging position 3 in order to avoid giving ultrasound energy. Then, keeping your foot steady, engage and accessible and safe part of the epi-nuclear shell and while aspirating it, use the chopper to help flip it up. This movement will mobilize the epi-nuclear shell and make aspiration easy.
Click below to learn the technique of flipping up the epi-nuclear shell:
