Phacoemulsification: Challenging and Interesting Cases

Pannet PangputhipongThailand Speaker Phacoemulsification: Challenging and Interesting CasesPhacoemulsification in complex cases is always challenging. Situations such as hard nucleus, intumescent cataract, posterior polar cataract, loose zonule, or small pupil require special surgical techniques to overcome the difficulties. In some patients, multiple complexities may occur simultaneously, making the procedure extremely challenging—sometimes described as a surgeon’s nightmare. This presentation will highlight selected interesting cases and demonstrate strategies to manage them safely, guiding surgeons on how to navigate through these “war zone” scenarios with confidence.Challenges in Soft Nucleus: Don’t Drown in Shallow WaterPhacoemulsification in soft nuclei can be challenging if inappropriate techniques are used. The soft nature of the nucleus makes nuclear disassembly difficult. Chopping and rotation are not easily performed because the chopper tends to cut through the nuclear mass when cracking or rotational force is applied, without achieving satisfactory results. The phaco tip also cannot hold the nucleus firmly enough during chopping or pulling. “Stab Test” using a 27g. hydrodissection canular to determine the hardness of the nucleus before performing hydrodissection is essential, in order to choose the most appropriate phaco technique. Special techniques such as Hydro Subluxation + Aspiration, Hydro Subluxation + Flip & Chop, Half Bowl + Rim Aspiration, and Chip & Flip (I. Howard Fine) will be discussed, including phacodynamics for soft nuclei. When proper techniques are applied, surgery can be performed safely and effectively.