Crater-and-divide technique for phacoemulsification of hard cataract

Purpose
The aim of this study was to evaluate a new technique for safe phacoemulsification of sizable, tough, leathery nuclear cataracts.
Patients and methods
Thirty eyes of 22 patients with hard cataract, recruited from the Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt, were included in the study. Informed consent was obtained from all patients. All surgeries were performed by the same surgeon (K.M.N.). A wide crater around 5.0 mm in diameter was created by down-slope carving up to 90% of the thickness of the nucleus, leaving the peripheral nuclear rim untouched. The phaco probe was applied at one edge of the crater without vacuum, and a spatula was applied at the opposite crater edge. The phaco probe and the spatula were pushed simultaneously in opposite directions toward the lens periphery, dividing the remaining nuclear rim into two halves. Each half, consisting of a thin nuclear rim, was withdrawn with high vacuum and emulsified in the suprabagal space.
Results
Intact posterior capsule was achieved in all cases. Clear cornea was reported on the first postoperative visit in 24 eyes and negligible postoperative early corneal edema in six eyes.
Conclusion
Our novel crater-and-divide phacoemulsification technique permits uneventful phacoemulsification of hard cataracts.