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I. Phacoemulsification Step by Step - Nucleus Fragmentation (1)

There are many methods for nucleus fragmentation. The more common techniques include "divide and conquer" and "phaco chop".  Generally the surgeon starts with "divide and conquer" and progresses to techniques like "phaco chop", as it is more efficient in terms of less ultrasonic power and less irrigation fluid required. It is important for the operator to be familiar with the phacoemulsification machine as different machines have various characteristics particular to that brand. Often the beginning surgeon uses a more experienced surgeons settings and once they are more familiar with the technique, then can modify the settings according to their own preferences. The phacoemulsification probe must be checked prior to entry into the eye. The irrigation and aspiration tubing must have a watertight seal. The silicone sleeve should be adjusted so that there is adequate tip protruding to perform nucleus fragmentation as well as allowing sufficient irrigation to avoid wound burns.  The sleeve should not have any leaks or damage around the irrigation ports. The micro-Bonn forceps are used to open the wound as well as providing counter-traction for insertion of the phaco tip. Although commonly done, it is not necessary to insert the tip bevel down and rotate within the anterior chamber. The irrigation must be turned on with the foot pedal in position "one" prior to entry to reduce air bubbles.