Piggyback miLOOP-assisted phacoemulsification combined with intraocular lens scaffold in hypermature cataracts

Hypermature cataracts with liquified cortex pose a higher risk for capsular complications due to a distended capsular bag, floppy posterior capsule, and absence of any cushioning epinucleus. Disassembly of a brunescent nucleus is more difficult because of the thickened, leathery posterior plate. Relying on mechanical forces, miLOOP nucleotomy reduces ultrasound time and is assured of bisecting the posterior nuclear plate. However, using this instrument with brunescent nuclei might impart significant stress on the zonular fibers and posterior capsule, particularly if there is no epinuclear shell. Evacuating the liquefied cortex and prolapsing one nuclear pole through capsulorhexis with ophthalmic viscosurgical devices create enough space to implant an intraocular lens (IOL) into the capsular bag beneath the undivided nucleus. This IOL scaffold shields the floppy posterior capsule and stabilizes the nucleus and zonular fibers during miLOOP nucleotomy. Combining and piggybacking these 2 techniques successfully avoided capsular and corneal complications in a series of 32 cases.