Supracapsular phacoemulsification: a capsule-free posterior chamber approach

We describe a technique that relocates the phacoemulsification process outside the capsular bag by transposing the nucleus through an intact 5.0 to 6.0 mm capsulorhexis. The upside-down nucleus is then returned to the posterior chamber, positioned above the anterior capsule in the "supracapsular space" where it remains throughout the phacoemulsification procedure of choice: cracking, chopping, manual prechoping, or traditional sculpting. The chief advantage of supracapsular phacoemulsification is greater efficiency, which is manifested in reduced emulsification time and energy. Disadvantages include the possibility of mild postoperative corneal edema during the earliest part of the learning curve, as well as inadvertent damage to the iris in cases with suboptimal pupil dilation.