In the USA, most surgeons use coaxial I/A for cortex removal and as such, they tend to make a single paracentesis along with the main incision. In other countries where bimanual cortex removal is more common, the surgeons need to make two paracentesis incisions. For my routine cases, I make just the one paracentesis, but for challenging cataract cases I find that 2 pararecenteses are better.
Many years ago, Dr Howard Fine taught me that there is virtually no downside to making an extra paracentesis incision or even two or three. These tiny incisions seal easily and do not impede healing, astigmatism, or the visual outcome. And in the case shown here, the paired paracenteses make the surgery easier. This patient has a prior history of uveitis with a small pupil and significant synechiae. The two incisions allow bimanual manipulation of the iris tissue and full access to the entire anterior segment.
Click below to learn from this challenging case with 2 paracenteses: