PMC6885315_01
Schematic diagram of step 1. (a) A screenshot to show the procedure that the entry point for a phaco tip is slightly axial to the rhexis and the phaco tip extended into and towards the very center of the nucleus with preset maximal energy. (b & c) Drawings of front side and lateral side
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PMC6885315_01_40662_2019_163_Fig1_HTML.jpg
Fig1
Given the thickness of the dense cataract, this maneuver was perfectly safe (Fig. 1). 
Schematic diagram of step 2. (a) A screenshot to show the procedure that an initial crack was created when the chopper was pulled towards the phaco tip with the phaco tip holding the nucleus. (b & c) Drawings of front and lateral side, respectively
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PMC6885315_01_40662_2019_163_Fig2_HTML.jpg
Fig2
With the phaco tip holding the nucleus, the chopper was pulled towards the phaco tip to create an initial crack (Fig. 2). 
Schematic diagram of step 3. Once the vacuum reaches the maximal setting, the surgeon slightly lifts the nucleus anteriorly (a) The surgeon moved the chopper from the distal position to the proximal position along the existing crack, and extended the crack till it was complete across the whole lens. In super dense lens, the surgeon placed the chopper at the bottom of the crack, and cut across the strands upwards (b, c and d)
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PMC6885315_01_40662_2019_163_Fig3_HTML.jpg
Fig3
In such circumstances, the surgeon injects some dispersive OVD underneath the nucleus and placed the chopper at the bottom of the crack, and cut across the strands upwards (Fig. 3a, b, c & d). 
Schematic diagram of step 4. When emulsifying the wedge-shaped fragments, the surgeon kept the bevel of phaco tip facing the sharp apex, using the chopper to stabilize the fragment
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PMC6885315_01_40662_2019_163_Fig4_HTML.jpg
Fig4
This prevented the sharp edges from rupturing the capsule (Fig. 4). 