Location of Phacoemulsification 1- Ant Chamber 2- Iris Plane 3- Post chamber 4- Supracapsular

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

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

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

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.

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

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

Chip and Flip Technique 1- Removal of the central core of the nucleus by sculpting and creating a nuclear bowl 2- Entire rim of inner nuclear bowl is removed and the posterior nuclear chip remains 3- Soft epinuclear bowl acting as a cushion and it should be tumbled or flipped and aspirated

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

Phacofracture technique 1- 4-quadrant nucleofracture technique needs a deep central linear groove 2- Two perpendicular groove is made

Divide & Conquer

Chopping Techniques described by Nagahara horizontal chopping (Nagahara) Vertical chopping (More recent)

 Vertical chopper designs have a short, sharpened tip that is able to penetrate the nucleus Chopper

 In horizontal chop, the chopper tip must hook the equator of the endonucleus peripherally beneath the anterior capsule. HORIZONTAL PHACO CHOP

 Benefits of phaco chop are particularly important for complicated cases such as brunescent nucleibrunescent nuclei white cataractswhite cataracts loose zonulesloose zonules capsulorhexis tearscapsulorhexis tears small pupilssmall pupils Phaco chop

Stop and Chop, Koch and katzen 1- Modified this procedure with addition of a central groove for better mobilizing the nuclear fragments Is a variation of divide and conquer a- divide the nucleus to halves b- chopping the remainng halves

Stop and chop

Vertical chop or quick chop Needs a chopper specifically designed for this technique

Nuclear Flip Technique: Brown has desribed a variation on earlier supracapsalar techniques 1- Needs a large capsulorrhexis 2- With hydrodisection the lens is flipped into the ant chamber where it is emulsified.