In situ nuclear disassembly: efficient phacoemulsification without nuclear rotation using lateral sweep sculpting and in situ cracking techniques

Chop and tumble nucleotomy - A technique for safe nuclear emulsification in posterior polar cataract

A modified phaco chop technique for nuclear emulsification in posterior polar cataracts with nuclear sclerosis that avoids hydrodissection or nuclear rotation has been described. After performing a vertical chop maneuver to divide the nucleus, two pie-shaped nuclear fragments are removed from either side of the initial chop. The remaining nuclear fragments are then sequentially tumbled toward the center using the second instrument and emulsified while maintaining an intact epinuclear shell, which safeguards the fragile posterior capsule. The technique was successfully performed in 62 eyes of 54 patients with posterior polar cataract and grade II-IV nuclear sclerosis. The Chop and Tumble nucleotomy is a safe and effective technique for phacoemulsification in posterior polar cataracts with nuclear sclerosis, where hydrodissection and nuclear rotation are typically avoided.

Stop and Flip: A Simple and Safe Phacoemulsification Technique

We introduce a simple, easy to learn, fast and safe technique to facilitate nucleus management in patients with zonular weakening in uncomplicated cases. The surgery begins with a temporal 3.2 mm clear corneal incision under topical anesthesia. Two side-port incisions are made on the inferior and superior sides. Anterior continuous curvilinear 5-6 mm diameter capsulorhexis and hydrodissection are performed to loosen capsule cortical attachments. The nucleus is not rotated, and an appropriated groove (80-90% depth) is sculpted using phaco machine. The groove is cracked into two hemispheres; lateral pressure and a side port manipulator. Then, 15-30 degree phaco tip is introduced and embedded into one hemisphere of nucleus beside the capsulorhexis edge at temporal or nasal part. After complete removal of the first hemisphere, the second is flipped again from bag into iris plane and phacoemulsified in the same manner.

Cystotome-assisted prechop technique

We describe a manual prechop technique to divide the nucleus using a cystotome. In the cystotome-assisted prechop technique, after the capsulorhexis, the surgeon-bent cystotome is inserted into the lens while the Nagahara chopper is set around the lens equator. The cystotome and the chopper are then brought together in the center to create a bisecting crack in the nucleus, dividing it cleanly into 2 hemispheres.

FINANCIAL DISCLOSURE

No author has a financial or proprietary interest in any material or method mentioned.

Phacoemulsification in cases of pseudoexfoliation using in situ nuclear disassembly without nuclear rotation

Purpose:

The purpose was to assess the safety and frequency of intraoperative complications of phacoemulsification using an in situ nuclear disassembly technique in pseudoexfoliation (PEX) cases.

Setting:

The work was done in Rustaq Hospital, Rustaq, Sultanate of Oman.

Materials and Methods:

This prospective, interventional, noncomparative study included 103 cases of cataract with pseudoexfoliation that underwent phacoemulsification with in situ nuclear disassembly using Alcon Infinity machine with Ozil handpeice and Kelman-style 45° phacoemulsification tip.

Results:

Of the 103 cases, 55 males (53.4%) and 48 (46.6%) females, one case developed posterior capsular rupture, and four cases developed zonular dehiscence that was partial in three cases and >180° in one case only. The best corrected visual acuity (BCVA) 4 weeks postoperatively using logMAR notation was as follows: 66 cases (65.1%) had BCVA of 0.30 or better (logMAR notation), and 37 cases (35.9%) had BCVA of 0.48 or less.

Conclusion:

Safe and efficient phacoemulsification without nuclear rotation could be achieved in cases pseudoexfoliation in which zonular weakness is a concern by utilizing the versatility of Kelman style phaco tip to do lateral sweep sculpting and in situ cracking techniques. It prevents zonular stress by avoiding manipulation or rotation of the nucleus in cases.