Quarters extraction technique for manual phacofragmentation(1)

In the quarters extraction technique, the nucleus is manually split and the fragments then removed. A 5.5 to 6.5 mm sclerocorneal single-plane incision is made. After capsulorhexis, hydrodissection, hydrodelineation, and surface cortex aspiration, the edge of the nucleus is prolapsed into the anterior chamber. The front quarter of the nucleus is cut and removed with a nucleus puncher. A corner of the remaining three quarters of nucleus is wedged into the wound and rotated out with a claw vectis. Among the initial 120 cases, there were no posterior capsule ruptures, and the mean endothelial cell loss at 3 months was 8.7% +/- 6.5% (SD). Because there is no need to deeply insert instruments at the time of nuclear fragmentation, this technique can be performed safely and easily in most cases except in eyes with very large nuclei.