1109: the mushy nucleus is tough to chop

Sometimes when we try to chop the nucleus, we realize that the cataract material is too mushy and the chopped just cuts through the tissue and the phaco tip loses vacuum holding power. How do you proceed when you notice this issue? You cannot split the nucleus effectively but you still must complete the case and safely finish nucleus removal. This video shows you my approach.

click to learn how to deal with the mushy nucleus that is tough to chop:


  1. i have been watching your videos for about a year and your pearls have helped tremendously. i have been in practice for 20 years. I had a case last week, everything going fine, patient had several episodes of violent coughing but no problems. i was finishing the cortex and was adding more viscoelastic to help tease away the remaining cortex and the patient coughed again and iris started to come out of the incision. I tried several maneuvers you had suggested including using the iris sweep to pull the iris out but it would not come out. I wanted to suture the main incision but could not because of the prolapse iris. i made a new incision, new paracentesis to pull the iris out, but did not work. I decided to put the lens in the bag, which i was able to do and finally able to pull the iris tissue out, the iris was not happy. I was able to put a stich in and remove the viscoelastic, there was some bleeding and some damage to the iris. Ultimately he did ok at post op day one with no leak, but some corneal edema. I am just not sure what i should have done once the iris started coming out.

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