1565: hesitant to perform flip and chop?

Multiple CataractCoach.com subscribers have emailed me to ask for pearls for success with phaco flip and chop. They have some hesitation in performing this technique because of fear of capsular damage and endothelial cell loss. I completely understand, but we can overcome both of these issues and increase our level of safety and efficiency for cataract surgery. The first step is ensuring that you have a reasonable sized capsulorhexis, which should be 5 mm in diameter for nuclear sclerosis of grades 1 to 3, or slightly larger at 5.5 mm in diameter for 4+ NS cases. This allows room for the nucleus to become partially prolapsed out of the capsular bag with continued hydro-dissection (with low force). The case shown here is a complete cataract case, from start to finish, showing you the technique in detail. Study the video carefully and I am certain that you can also achieve this. Note that I have performed this technique thousands of times, so you do not need to start off aiming for this level of efficiency. Just take it slow and the efficiency will come with experience.

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