Lift and crack technique for risky cataract cases

We describe a technique to manage dense cataract cases. After a capsulorhexis of 6.0 to 7.0 mm diameter has been created, the phaco tip is inserted into the nucleus centrally and high vacuum is used to lift the nucleus and elevate it with a tilt to protrude outside the capsular bag distally. The chopper is used to segment the nucleus centripetally, starting from the lens equator or just behind, without applying stress to the capsular bag or zonules. Further phacoemulsification is maintained by holding the nucleus centrally and chopping it into smaller triangular sectoral pieces. In this horizontal chopping technique, which is done just outside the capsular bag, grasping the nucleus in the center and elevating it with high vacuum instead of depressing one edge of the nucleus to elevate the other edge prevents additional stress to the capsule and zonules.

Neither author has a financial or proprietary interest in any material or method mentioned.