3113: resident soft nucleus divide and conquer
Attempting divide and conquer or even just sculpting a groove in a soft nucleus is not the ideal technqiue, as soft nuclear tissue compresses, molds, and cheese-wires under mechanical pressure rather than snapping along clean fracture lines. While novice residents often default to grooving out of familiarity, sculpting soft lens material can be risky since the ultrasonic power and vacuum can quickly go through the lens material and then increase the risk of a posterior capsule rupture. A superior approach for soft cataracts involves aspiration-only nuclear removal or hydro-prolapsing the lens material to vacuum the nucleus safely. Tailoring nuclear disassembly parameters to match lens density prevents unnecessary capsule stress and maximizes fluidic efficiency during early surgical training. Watch the video to see how a resident navigates a soft nucleus using divide and conquer, and explore more efficient alternative techniques. What technique or parameter adjustments do you teach residents when transitioning away from grooving soft cataracts? Please comment your thoughts below.
Flip the nucleus out of the bag and perform supracapsular phaco. Dave Brown showed this years ago with an olive tip cannula. I perform it routinely using the Terry Squeegee on a provisc syringe.