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Thank you again Dr. Kim. Just a small correction: the person how published the ACM technique was Prof. Mike Blumenthal many year ago with the "mini-nuc technique", even before the phacoemulsification and many of us are still using the ACM in routine phaco cases. About the hydro-jet - I agree with you. It should be done very gently

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Thank you Dr. Kim for sharing your video. I have few things to say about your teqnique: 1) about irrigation with another canule during aspirating the cortex: You said that it was not published but it is not true - we are using many many years in Israel the method of anterior chamber maintainer (ACM) so it was published and I'm using ACM in all cases and also most of our colleagues in Israel, many years especially in complicating cases as you showed. and when you use the ACM, it is very easy to get rid of cortex using gentle hydro-jet in addition . 2) and about the more important thing: you managed well extracting the cataract and implanting the IOL but without fixating the IOL after few months - all the complex of the IOL-bag-CTR will be subluxated! so in those cases I recommend fixation of the IOL, or the bag-CTR complex during the initial surgery to avoid that. Thank you again, Ori Mahler, Israel

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Dr. Mahler, thank you for your excellent comments and contributions. And pardon me for not being aware and not giving you credit for your technique. Congratulations for developing the ACM technique. Of course, what I do is quite different as I do not use an ACM, which is another device to put in. I just use the I&A handpiece because I already have it ready. But as you call it, the "hydro-jet", is definitely the same concept I do and so I thank you for publishing this very important technique. I do think it's important to reiterate NOT to do the hydro-jet into the sulcus space as this will cause iris pigment dispersion if the jet is too forceful, but otherwise, if it's done correctly, in the bag, it works very well and I employ it on all my cataract cases. Thank you for your excellent comment and for your contributions. Best wishes. Brian Kim

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Excellent video, Dr Kim! The pearl about pulsing the BSS to release the adherent cortex is extremely useful: often we end up pulling the bag and losing capsular support using the I/A probe at that time, and this technique really can avoid that.

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