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I would like to offer some comments to the interesting video shown by Dr Prasad. I routinely use the same phacomachine Stellaris from B&L and I really think it offers an excelent intraoperative control. In particularly the dual-linear foot pedal control for the aspiration line allows the surgeon to modulate the vacuum as needed, therefore increasing the safety. In the case shown, I would notice that there was a significant collapsing of the anterior chamber when the phaco-tip disoccluded at the end of each fragment phacoemulsification. Clearly, that was due to an inbalance between infusion and aspiration. The vacuum settings used were not the highest, unfortunately it is not possible to see what the height of the irrigation line was. I can either immagine that the irrigating chop is not able to provide as much inflow as needed, or that there is a significant leaking through the corneal incisions. Incresing the bottle-height might improve the anterior chamber stability. A further point regards the switch from the phaco-phase to the I/A-phase: given the irrigation chop provides the infusion, it might be kept into the AC and only the aspiration cannula would be needed. Lastly, the B&L MI60 IOL can be implanted through a 1.8 mm incision, whereas in the video the incision was enlarged to much more than 2 mm. Gianluca Carifi, MD

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