Fig. 16. Divide-and-conquer phacoemulsification. A. Divide-and-conquer techniques are particularly suited for glaucoma patients with moderately hard nuclei and small pupils. The small incision prevents wide fluctuations in chamber depth and maintains normal IOP. Perform deep sculpting with moderate phaco power and minimal vacuum settings at 90-degree angles until the nucleus can be divided into four pieces. Modify the instrument settings to encourage capture of the pieces into the phaco port at the same time protecting the cornea. Increase the vacuum and aspiration, decrease the phaco power, and activate the pulse and burst modes. Emulsify the nucleus with a divide-and-conquer approach in the middle of the pupil slightly below the pupillary plane. Remove the epinucleus and cortex and polish the capsule. |