This is a complete cataract case, shown start to finish, where the anterior lens capsule wrinkles upon attempted puncture for starting the capsulorhexis. I could have used a sharp needle or cystotome instead and it would have an easier time piercing the lens capsule, but then I would not be able to gauge the degree of zonular laxity. While the capsule wrinkles during the puncture, it does not wrinkle during the tearing of the capsulorhexis and that is a good sign. While there is some zonulopathy in this case, using a capsular tension ring is not required and I anticipate that the patient will have a stable IOL for the rest of his life. Before watching the video, what would be your technique of nucleus removal?
For Phaco technique for low zonulopathy I use horizontal chop
Flip and chop has become my goto technique except in cases of shallow anterior chambers. I have done stop-and-chop, prechop, and phaco chop. In my hands, flip and chop is the most efficient and safest (execept in cases of shallow AC’s). It seems to me that more and more cases of phaco chop are being shown recently on cataractcoach.com.