When a resident or beginning surgeon is performing phaco on a soft posterior sub-capsular (PSC) cataract, there is one critical principle to keep in mind: get the nucleus away from the posterior capsule. These patients are younger and the nucleus is much softer with minimal sclerotic changes. If a groove is created for a divide-and-conquer technique, just a little too much energy will result in the phaco tip going too deep into the nucleus and hitting the posterior capsule. Even if grooves were sculpted with the utmost care, cracking the nucleus into fragments is difficult since the instruments just mush the cataract. The key is to get the nucleus up, out of the capsular bag using hydro-dissection. This resident does a great job with this case because the nucleus is split once it is already out of the capsular bag and away from the posterior capsule.
click to learn how this resident does a great job with a soft PSC cataract: