We describe a technique for performing safe phacoemulsification of a Morgagnian cataract using the intraocular lens (IOL) scaffold. An IOL scaffold has been used in cases in which posterior capsule rupture has occurred, leaving nonemulsified nuclear pieces. The scaffold provides a barrier that prevents the nuclear fragments from falling posteriorly into the vitreous cavity. Our technique uses the IOL as a scaffold to prevent the vulnerable posterior capsule from rupturing during nuclear emulsification in Morgagnian cataract. The technique prevents rupture of the floppy posterior capsule by providing a constant support to it. The scaffold provides stable inflation of the capsular bag and prevents inadvertent emulsification. Concurrently, it prevents dehiscence of weak zonular fibers by minimizing the stress on the zonular apparatus.

Purpose: To describe a new, en masse, stepwise technique for purely soft cataracts. Methods: RAPID, a soft cataract phacoemulsification technique, is an acronym-based procedure where R is rotation of nucleus, A is alignment of phacoemulsification tip sideways, P is placement of tip adjacent to the nuclear rim, I is impaling of tip into nuclear rim and D is devouring wherein nucleus is aspirated/emulsified. RAPID technique was performed in 54 eyes of 54 patients (31 males and 23 females; mean age 46.35±3.95 years). The soft nucleus was emulsified, after performing hydrodissection, in a stepwise manner in the safe zone away from posterior capsule and corneal endothelium. Centurion/Infiniti Phacoemulsification system (Alcon Laboratories, Inc.) was used with vacuum parameters at 475 mm Hg and an aspiration flow rate of 0–45 mL/min in linear mode. The primary outcome measures were cumulative dissipated energy (CDE), ultrasound time (UST), amount of fluid used, surgical complications and mean endothelial cell loss. Results: Phacoemulsification with IOL implantation was performed successfully in all patients without any intraoperative complications. CDE was 1.03±0.61. Total UST for nuclear emulsification was 3.84±3.27 seconds and fluid used was 10±2.35 milliliters. Postoperative follow-up examinations were done on 1, 4, 14, 30 and 90 days. Mean percentage of endothelial cell loss was 7.05±2.65% (mean endothelial cell counts were 2383.75±105.21 cells/mm 2 preoperatively and 2215.78±114.9 cells/mm 2 3 months postoperatively). Conclusion: RAPID is an en masse non-fragmentation technique for purely soft cataracts. This technique requires neither any specialized instrumentations nor the use of high vacuum with complimenting surge preventing software. Simple stepwise multi-planer approach of RAPID technique allows easy and fast emulsification of soft cataracts with simultaneous safeguarding of posterior capsule and corneal endothelium.

Our case report highlights the potential complication of DM detachment during insertion of foldable IOL. We performed stab incisions in the pre-DM space to achieve quick and successful repositioning of the detached DM with favorable results.

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PurposeTo describe a trypan blue dye staining technique under air, a modification of the previously described 30 G needle under-air technique.DesignThis is a prospective, randomized study of 1,000 eyes of 952 patients undergoing phacoemulsification in a private practice setting from January 2015 to August 2016. Three variants as a modification of the previously known 30 G needle technique are described. In our technique, after injecting one drop of the dye under air, the needle is kept in the anterior chamber (AC) for 15 seconds. In the second variation, along with the additional hold time, 0.05 mL air is injected prior to dye injection to deepen the AC in eyes with shallow ACs or in cases with increased posterior pressure. The third variation is the selective painting approach in which more than one drop is injected for a homogenous staining.Main outcome measuresThe main outcome measures were safety and reproducibility of the technique along with homogeneity and uniformity of the anterior capsule staining.ResultsAC remained stable during the hold time of 15 seconds with no egress of air. No iatrogenic trauma occurred in any of the cases. All cases had a homogeneously stained anterior capsule. The staining intensity was excellent in 80.8% of the eyes and good in 19.2% of the eyes.ConclusionThis is a safe, simple, and cost-effective technique which achieves consistent, uniform, and reproducible staining. It overcomes the shortcomings of the known 30 G needle technique.