This patient certainly needs cataract surgery because the dense nucleus has a large degree of central opacity and that has left her with 20/200 vision. The case starts out routinely but when we attempt to perform phaco chop, we realize that it is a dense fibrous nucleus. This fibrous nature of the cataract means that our chops in the nucleus do not propagate completely and we are unable to achieve fully separated pieces.
What’s the solution? First chop small segments of the peripheral nucleus which is not as dense or fibrous. Then once that is completed, the remaining central endo-nucleus can be attacked with more working room within the eye.
You will certainly encounter patients with this type of dense, fibrous nucleus in the future. Contributing factors include advanced nuclear sclerosis and age. In some cases even certain psychiatric medications can contribute to this type of cataract formation.
Watch the video below to learn the technique of peripheral nucleus chopping: