Linear marks seen during cortex removal

For surgeons with just a few years of experience, the part of cataract surgery where a posterior capsule break is most likely to occur is during phaco. The phaco probe is an exposed metal tip and if it comes into contact with the posterior capsule, it can easily damage it in just a fraction of a second.

For more advanced surgeons, who are seasoned with many years of experience, a posterior capsule rupture is more likely to occur during irrigation/aspiration of lens cortex material. As we strip the cortex from the delicate capsular bag, we can experience a capsular break, particularly if there is a pre-existing weakness.

The case shown here is a 94-year-old patient and that means that the tissues are far more delicate. As explained in a previous video, cataract surgery on nonagenarian patients is different and extra precautions must be taken to account for the weaker tissues. The nucleus is removed efficiently, but then during cortex removal, we notice some linear marks on the posterior capsule. This puts me on high alert and we slow down the procedure, back-flush the probe fluidics, and carefully evaluate the situation. What do you think is going on here?

Click below to see what is happening during this challenging cataract case:

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