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1- Ant Chamber 2- Iris Plane 3- Post chamber 4- Supracapsular 5) Endolenticular

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1- Ant Chamber 2- Iris Plane 3- Post chamber 4- Supracapsular 5) Endolenticular

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Anterior Chamber 1- Post capsule damage is minimized 2- Risk of corneal endothelium is more 3- Used if the posterior capsule has ruptured or patient has high myopia

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Iris Plane 1- Risk of damage to corneal endothelium and post capsule is reduced. 2- Good for small pupils. 3- Often desirable for beginners.

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Posterior Chamber 1- Preferred location for phaco 2- More risk for post capsule

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Supracapsular Phaco (1997) Malony 1- More recent innovation 2- Reduces the stress on the zonules during nucleus manipulation. 3- Can be used in small-pupil cases. 4- Needs a large capsulorrhexis. 5- Nucleus is flipped with hydrodisection.

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Endolenticular 1- Uses a very small opening in ant capsule 2- Has maximum endothelial protection 3- Future possibility of injecting synthetic lens material into an almost intact capsular bag 4- Increased risk of posterior capsule rupture during both hydrodissection and emulsification

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Types of Phacos 1 ) whole nucleus removal central nuclear sculpting and creation of a D-shaped nuclear bowl

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1) Whole-nucleus removal The nucleus can be emulsified as a whole 1- In either the iris plane or the post chamber 2- Needs large capsular opening

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2) Chip and Flip Techniques a) Removal of the central core of the nucleus by sculpting and creating a nuclear bowl b) Entire rim of inner nuclear bowl is removed and the posterior nuclear chip remains c) Soft epinuclear bowl acting as a cushion and it should be tumbled or flipped and aspirated

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3) Phaco Fracture Technique Gimbel developed a useful technique for hard nuclei a) 4 quadrant nucleo fractures technique. b) Linear groove is created perpendicular to the first

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Nucleus-splitting techniques 1- Hydrodelination separates hard endonuclus 2- nucleus is divided into pieces before removal from the capsular bag

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