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J. Phacoemulsification Step by Step - Nucleus Fragmentation (2)

Once the tip is in the centre of the rhexis downward sculpting can be performed with the foot pedal in position "three". Grooving is varied according to the density of the nucleus with a shorter narrow groove for softer nuclei and wider longer grooving for denser nuclei. The grooving is continued until there is a change in the red reflex. If performing phaco chop, the second instrument such as a Rosen splitter can we used. The nucleus initially is impaled by the phaco tip in position "three" and held with vacuum in position "two". The tip of the chopper is introduced carefully under the edge of the anterior capsulorhexis and a slight downward motion bringing the chopper instrument towards the tip but not quite touching. This will propagate a crack in the nucleus resulting in spitting the nucleus in half. Subsequent chop manouvres are performed to the nucleus, with the pieces emulsified and aspirated. Particular care is taken with the final nuclear fragment as there is increased risk of the posterior capsule being aspirated and damaged.