Endocapsular deep-wedge-removal phacofracture.

We present a nucleus disassembly technique that allows safe debulking of two thirds of the nucleus by removal of a deep, central, equilateral triangular wedge of nucleus with no manipulation or rotation. The resulting equilateral triangular wedge-shaped cavity yields 3 points of weakness at each corner that facilitate cracking the remaining peripheral nuclear rim into 3 equal segments. Each segment is easily gripped by short bursts of phaco power and pulled into the central cavity for safe endocapsular phacoemulsification, an approach that protects the cornea. This technique is applicable to most cataracts regardless of consistency. It prevents zonular stress by avoiding manipulation or rotation of the nucleus in cases in which zonular weakness is a concern. The technique was used in 95 consecutive eyes, with no posterior capsule tears, vitreous loss, or zonule disturbance.