Our guest surgeon is an amazing surgeon, Dr Neto Rosatelli from Brazil. He presents a very, very dense cataract in this case. The nucleus is so dense and opaque that the lens appears to be black even with maximum microscope illumination. In a case like this the challenge is nucleo-fractis: how do you safely split this dense nucleus into smaller fragments? There are many options such as placing the chopper behind the posterior nuclear plate and trapping the nucleus with the phaco probe so that a high degree of force can be used. You could also use a snare / loop to mechanically split the nucleus. A femtosecond laser would not be able to penetrate this nucleus very well since it is so opaque and laser light needs to be able to be transmitted. If you are a less experienced surgeon, a better technique for this case may be to perform MSICS. Our guest surgeon uses a sharp chopper to cut and then split the nucleus. I think you will enjoy learning from this video.
