I have often advocated the use of the flip and chop technique whereby part of the lens equator is brought out of the capsular bag to facilitate chopping. To accomplish this, I typically use a gentle fluid wave of BSS with a 27g blunt cannula on a 3 cc syringe to perform hydro-dissection. Our guest surgeon has an alternative: using the vacuum holding power of the phaco probe to bring the nucleus equator out of the bag. The key here is to understand the fluidics and have the foot pedal control. You must have a sufficiently high vacuum level and then embed the phaco probe by briefly going to position 3 to deliver a small burst of phaco power, then retract the foot back to position 2 to maintain the vacuum level without further ultrasonic power delivery.
