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my preferred technique for soft lenses, and when capsule is compromised. i agree it should be familiar to all surgeons, so that they can use it when capsule compromised.

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Thank you Dr. Raviv, for a great video, appreciated! I use a similar technique, routinely: I float out the entire lens, completely into the AC, and eat up the entire lens there, anterior to the capsulorhexis. To protect the endothelium: 1) I use a dispersive OVD to coat the endothelium; b) I use a reverse chop (between 2nd hand instrument and phaco tip), to break up the nucleus mechanically so I use minimal or no phaco power. It works for 99% of the up to 3+ NS lenses. I am sure this phaco float technique has long been described also.

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The main goal of Phaco surgery is to remove Cataract with the almost safe and effective technique that can lead to the lowest degree of surgical damage and in the same time to the highest surgical respect to the ocular tissues. The present technique is good,but i want to add one point. The modern Phaco technology provides with very good stability of AC, effective phaco pulses, high safety and very good phaco-dynamics. In the other hand we have a big benefit of Visco devices and different chops. I prefer to work with the approach of Phaco in the bag with chop technique.In the video we can see the following signs:

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Whenever a large audience of ophthalmologists is polled on their preferred technique, only about 5% of them favor flip/supracapsular (with divide and conquer in the majority and chopping second). I believe this reflects our training over the last couple of decades, and predict future percentages will shift more towards chop and supracap. I typically perform 60% supracap and 40% chop, deciding predominantly on the density of the nucleus (supracap for < 2.5+ NS, and vertical chop for >2.5+NS cataracts). Factors such as zonular instability, small IFIS pupils, deep chambers will tip me towards supracap even in denser lenses, whereas manifest endothelial disease, will keep me in the capsular bag.

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During my last two phaco's the nucleus was flipped unintentionally, but instead of rotating the nucleus, i impeded the phaco tip into the nucleus and continued with "supracapsular horizontal chop".

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I have been using this flip/supracap technique for a few months since I started using Alcon's OZIL phaco, I flip the nucleus partially out of the bag and chop it as I go along. With adequate Viscoat and torsional phaco even with hard cataracts the cornea is clear the following day. I think its a great technique which all phaco surgeons should learn as it can help hugely in situations with unstable zonules and deep AC. Thank you for the great video.

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In the never ending quest for the ideal phaco technic phaco-tilt is an interesting option. I did the classic David Brown Phaco Flip technic for 4 to 5 years with great enthusiasm but eventually moved to the chop technic because I had to admit my corneas were too often taking longer to clear. I think tho that I will take another look at this technic. I think some form of flip or tilt or mid-chamber technic should be part of every surgeon's armamentarium as it is unnecessarily laborious to use a pure post chamber technic in a very deep AC. Much smpler to flip it up and phaco it out. Philosophically I am inclined to agree with Prof. Thomas Neuhann who said "Cataract surgery involves learning a series of six or seven tricks to remove the lens." I firmly believe this should be one of those "tricks."

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This technique is useful in cases of significant phacodonesis to minimize zonular stress.

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