'Decrease and conquer' improves control, safety of phaco in hard nucleus cataracts

Hong Kyun Kim, MD, PhD describes a hard nucleus phacoemulsification method called "decrease and conquer," in which the endonuclear core is separated from the epinucleus. It's not a new technique. Surgeons in India have been doing it for years. But it's very useful and pretty much guarantees me a clear cornea the next day no matter how brunescent the cataract.

The purpose of the method is to offset certain limitations of the conventional neofractis technique, where complete division of the hard nucleus is a necessity if the operation is going to be safe and efficient. This can be challenging and sometimes results in complications. The decrease and conquer technique, however, does not require complete fragmentation. It involves three steps: circumferential disassembly, decreasing the central nucleus volume, and conquering the remnant. Because it is performed along the loosely adhesive lamellated zone instead of the radial suture plane, separation of the dense nuclear core from the epinucleus is easy, even in the case of an unusually dense brunescent nucleus.