Bimanual irrigation/aspiration for cortex removal has an advantage: it is easy to switch hands and then access a full 360 degrees of the capsular bag. It does require a third incision, and perhaps for that reason, coaxial irrigation/aspiration is more commonly performed in the USA. We have shown examples of new instruments like the transformable I/A handpiece which allow easier access to the sub-incisional area. But what if you don’t have this extra instrumentation?
You can simply use a 27g cannula on a 3cc syringe which is partially filled with balanced salt solution. This can be placed in the paracentesis and then angled towards the sub-incisional space where it can be used to suction the remaining cortex by pulling back on the plunger. But there is one step that you must to prior to attempting this move: fill the capsular bag with viscoelastic such as the cohesive OVD used to prepare for IOL insertion. This will help keep the capsular bag expanded and prevent iatrogenic damage.
Click below to learn this easy surgical pearl: