PMC6369501_01
The illustration and intraoperative photographs present major steps of "crack, reduce, and implant" phaco technique. (a, g) Nucleus is cracked into two halves following vertical groove formation; (b, h) dense core of each halves is shaved sideward in the capsular bag to decrease nucleus load for further steps with low vacuum and phaco power; (c, i) with the assistance of ophthalmic viscosurgical devices (OVD), nuclear halves are prolapsed from the capsular bag to the iris plane; (d, j) anterior chamber and capsular bag are filled with OVD and a foldable intraocular lens (IOL) is implanted. Posterior capsule is now fully protected. (e, f, k, l) The nucleus is chopped into small pieces and removed far from the corneal endothelium with confidence, and the remaining cortical material is aspirated. Surgery is completed without complication.
CRIM2019-9043417.001.jpg
PMC6369501_01_CRIM2019-9043417.001.jpg
fig1
After hydrodissection, central vertical groove was formed, and nucleus was cracked into two halves (Figures 1(a) and 1(g)). Using the phaco needle, core nucleus (which is the rock-hard part of the lens) of the two halves was hollowed sideward in the capsular bag (using low vacuum (linear increment with an upper limit of 80 mmHg) and power (linear increment with an upper limit of 80% torsional amplitude) settings) (Figures 1(b) and 1(h)). The nuclear halves were removed from the capsular bag using the phaco tip, and each half was pushed to one side on the iris plane with assistance of OVD (Figures 1(c) and 1(i)). Capsular bag was inflated with OVD, and a foldable IOL was implanted (Figures 1(d) and 1(j)). Then, nuclear halves were chopped into small pieces and removed as far as possible from the corneal endothelium, which is also protected by dispersive viscoelastic (Figures 1(e), 1(f), 1(k), and 1(l)).