Using a 2.4mm incision, I remove a fairly dense, 3+ brunescent nuclear cataract from a patient whose other eye has only peripheral vision. I demonstrate using trypan blue to aid visualization of the capsulorhexis, and show how an OVD can be used to actually reposition an anterior subcapsular opacity prior to creating the capsulorhexis. A detailed presentation of the impale and chop technique follows with additional pearls including how to keep the phaco tip cool, and the advantage of using a slightly oversized surgical glove.
An eye with pseudoexfoliation exhibits moderate zonular laxity and a small pupil that requires enlargement. The options (capsule tension ring, capsule retractors, or a manual