Location of Location of PhacoemulsificationPhacoemulsification

11 - -Ant ChamberAnt Chamber22 - -Iris PlaneIris Plane

33 - -Post chamberPost chamber44 - -SupracapsularSupracapsular

Anterior ChamberAnterior Chamber11 - -Post capsule damage is minimizedPost capsule damage is minimized

22 - -Risk of corneal endothelium is moreRisk of corneal endothelium is more

33 - -Used if the posterior capsule has Used if the posterior capsule has ruptured or patient has high myopia ruptured or patient has high myopia

Iris PlaneIris Plane11 - -Risk of damage to corneal Risk of damage to corneal

endothelium and post endothelium and post capsule is reducedcapsule is reduced..

22 - -Good for small pupilsGood for small pupils..

33 - -Often desirable for beginnersOften desirable for beginners..

PosteriorPosterior ChamberChamber

11 - -Preferred location for phacoPreferred location for phaco

22 - -More risk for post capsuleMore risk for post capsule

Supracapsular Phaco (1997) Supracapsular Phaco (1997) MalonyMalony

11 - -More recent innovationMore recent innovation

2- Reduces the stress on the zonules during 2- Reduces the stress on the zonules during nucleus manipulation.nucleus manipulation.

33 - -Can be used in small-pupil casesCan be used in small-pupil cases..

44 - -Needs a large capsulorrhexisNeeds a large capsulorrhexis..

55 - -Nucleus is flipped with hydrodisectionNucleus is flipped with hydrodisection..

EndolenticularEndolenticular11 - -Uses a very small opening in ant capsuleUses a very small opening in ant capsule

22 - -Has maximum endothelial protectionHas maximum endothelial protection

33 - -Future possibility of injecting synthetic lens Future possibility of injecting synthetic lens material into an almost intact capsular bag material into an almost intact capsular bag

44 - -Increased risk of posterior capsule rupture Increased risk of posterior capsule rupture during both hydrodissection and during both hydrodissection and emulsificationemulsification

Whole-nucleus removalWhole-nucleus removal

The nucleus can be emulsified as a wholeThe nucleus can be emulsified as a whole

11 - -In either the iris plane or the post In either the iris plane or the post chamber chamber

22 - -Needs large capsular openingNeeds large capsular opening

Chip and FlipChip and Flip TechniqueTechnique11 - -Removal of the central core of the Removal of the central core of the

nucleus by sculpting and creating a nuclear nucleus by sculpting and creating a nuclear bowl bowl

22 - -Entire rim of inner nuclear bowl is removed Entire rim of inner nuclear bowl is removed and the posterior nuclear chip remainsand the posterior nuclear chip remains

33 - -Soft epinuclear bowl acting as a cushion and Soft epinuclear bowl acting as a cushion and it should be tumbled or flipped and it should be tumbled or flipped and aspiratedaspirated

Nucleus-splitting techniquesNucleus-splitting techniques

11 - -Hydrodelination separates hard Hydrodelination separates hard endonuclus endonuclus

22 - -nucleus is divided into pieces before nucleus is divided into pieces before removal from the capsular bag removal from the capsular bag

Phacofracture techniquePhacofracture technique

11 - -44--quadrant nucleofracture technique quadrant nucleofracture technique needs a deep central linear needs a deep central linear

groovegroove

22 - -Two perpendicular groove is madeTwo perpendicular groove is made

Divide & ConquerDivide & Conquer

Divide & ConquerDivide & Conquer

Divide & ConquerDivide & Conquer

Divide & ConquerDivide & Conquer

Divide & ConquerDivide & Conquer

Chopping Techniques Chopping Techniques described by Nagahara described by Nagahara

horizontal chopping horizontal chopping (Nagahara)(Nagahara)Vertical chopping (More Vertical chopping (More recent)recent)

Vertical chopper designs have a short, sharpened tip Vertical chopper designs have a short, sharpened tip

that is able to penetrate the nucleusthat is able to penetrate the nucleus

ChopperChopper

In horizontal chop, the chopper tip must hook the In horizontal chop, the chopper tip must hook the

equator of the endonucleus peripherally beneath the equator of the endonucleus peripherally beneath the

anterior capsule.anterior capsule.

HORIZONTAL PHACO CHOPHORIZONTAL PHACO CHOP

Benefits of phaco chop are particularly Benefits of phaco chop are particularly

important for complicated cases such as important for complicated cases such as • brunescent nucleibrunescent nuclei• white cataractswhite cataracts• loose zonulesloose zonules• capsulorhexis tearscapsulorhexis tears• small pupilssmall pupils

Phaco chopPhaco chop

Stop and Chop, Stop and Chop, Koch and katzenKoch and katzen

11 - -Modified this procedure with addition Modified this procedure with addition of a central groove for better of a central groove for better mobilizing the nuclear fragmentsmobilizing the nuclear fragments

Is a variation of divide and conquerIs a variation of divide and conquer

a- divide the nucleus to halvesa- divide the nucleus to halvesb- chopping the remainng halvesb- chopping the remainng halves

Stop and chopStop and chop

Vertical chop or quick chopVertical chop or quick chop

Needs a chopper specifically designed Needs a chopper specifically designed for this techniquefor this technique

Nuclear Flip Technique:Nuclear Flip Technique:

Brown has desribed a variation on Brown has desribed a variation on earlier supracapsalar techniquesearlier supracapsalar techniques

11 - -Needs a large capsulorrhexisNeeds a large capsulorrhexis

22 - -With hydrodisection the lens is With hydrodisection the lens is flipped into the ant chamber flipped into the ant chamber where it is emulsifiedwhere it is emulsified..