Even with good dilation, cortex can be hidden at the capsular bag equator. In this case, the dilation is about 7 mm at the beginning of the surgery, but still there is a large piece of lens cortex hidden at the capsular bag equator. If this piece is left inside the eye, then it will swell overnight and become much larger and it will free itself from the capsular bag. On post-op day 1 there will be this large piece of lens material right in the visual axis and you will wonder how it got there. This video is the answer.
We need to mentally keep track of the lens cortex as we operate. This patient has a particular spot on the cataract that has a fibrotic lens opacity and it remains there during nucleus removal and during cortex removal. Since we remembered that it was there, after the IOL is inserted, the chopper is used to lift up the iris in that quadrant to reveal the large retained cortical fragment. It is removed successfully and the patient has a great outcome.
click below to learn from this very important video: