In this interview, Dr. Lisa Arbisser describes and demonstrates her approach for managing the brunescent or rock-hard cataract. The method, which she introduced in practice in 2004 and has since dubbed "circumferential disassembly with cross-action vertical chop," is essentially a means of debulking the lens from the inside out. Using noncontinuous phacoemulsification and a Rosen splitter, Dr. Arbisser relies on short bursts of energy to create multiple superficial radial chops, slowly debulking the endonucleus away from the outer nucleus and epinucleus. Once the lens is divided, the hardest inner nuclear material is emulsified within the posterior chamber. Critical to this technique are the liberal use of both cohesive and dispersive viscoelastics to protect the endothelium, and hydrodissection to allow full rotation of the nucleus.

Financial Disclosures: Dr. Arbisser has no financial interests to disclose.