Performing phacoemulsification in an eye with corneal scarring from a prior alkali burn presents a significant visualization challenge. The opacified stroma scatters the operating microscope light, creating a haze that obscures the details of the anterior capsule and the depth of the nuclear grooves. To overcome this, the most effective tool in your armamentarium is endo-illumination. I was fortunate to visit our guest surgeon, Dr Sergio Kwitko in Porto Alegre, Brazil and I am so impressed with his incredible skill. By bypassing the scarred cornea and delivering light directly into the anterior chamber, you eliminate the backscatter that plagues traditional coaxial lighting. A fine-gauge light pipe provides a brilliant internal light source, illuminating the lens from behind or from the side. This allows you to clearly visualize the edge of your capsulorhexis and safely judge the depth of your phaco tip during sculpting. When the view is hazy, endo-illumination transforms a potentially dangerous procedure into a controlled and predictable case. It is all about the view; if you can see the structures clearly, you can operate with confidence.
