By Dr. Amar Agarwal
    Video Journal of Cataract and Refractive Surgery
    Cataract/Anterior Segment

    Dr. Amar Agarwal shows how to use sleeveless phaco tip-assisted levitation to manage a dropped nucleus. He begins by suturing the corneal wound, and performing a 23-gauge, 3-port pars plana vitrectomy. A posterior assisted levitation technique is attempted and fails. Vitrectomy is done to free the nucleus from surrounding vitreous, and 1 of the sclerotomies is enlarged with an MVR blade to enable the sleeveless phaco probe to enter the eye. Using only the suction mode, the phaco probe lifts the nucleus off the retina and brings it into the anterior chamber. A 3-piece IOL is injected into the anterior chamber below the nucleus. Phocoemulsification is done with the air pump on, while the IOL below the nucleus acts as a scaffold, preventing fragments of nucleus from falling back into the vitreous. The IOL is placed in sulcus and an anterior vitrectomy is done to remove the vitreous from the anterior chamber.