In cases where we perform hydro-delineation and we have a separate epi-nuclear shell to remove, what is the best technique. It is easier and more efficient to remove it using the phaco probe since the aspiration port on the I/A hand-piece is so small. This video shows the technique to safely remove the epi-nucleus with the phaco probe and we discuss the appropriate settings for the phaco machine.
click below to learn how I prefer to remove the epi-nucleus during phaco:
I love complete cases. Thank you doctor
Great case- I don’t like epinuclear bowls! One thing I’ve noticed during my cases is post occlusion surge- I’ve decreased both my aspiration and my vacuum. It makes me nervous about reaching out for nuclear pieces and the epinucleus with the phaco probe. I end up tumbling pieces forward and phaco-ing more anterior on these cases and get more edema than I’d like. Any other settings I can adjust?
You can increase the infusion pressure (or bottle height). See this series:
https://cataractcoach.com/category/phaco-fundamentals/