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EW CATARACT 41 October 2016 Houston, said she would advise staining with trypan blue as it helps show where the anterior capsule actually is. For those just starting out with phaco chop, Dr. Al-Mohtaseb also said that doing both hydrodis- section and hydrodelineation could be helpful. Hydrodelineation leaves the epinuclear shell for protection, while hydrodissection allows for good rotation of the lens epinucleus. Moving forward with the ficti- tious case, Dr. Zavodni said Theresa did indeed stain the capsule and performed both hydrodissection and delineation. Planning to horizontal chop, Dr. Zavodni asked where she should attempt to impale the nucle- us at this stage. Dr. Chang offered his pearls for proper chopper placement, saying that with horizontal chop, the key is for the chopper tip to work with- in the epinuclear space. Though a "somewhat blind maneuver when you have to go just under the pupil margin," causing the surgeon to worry about whether the chopper is inside or outside the bag, Dr. Chang recommended that transitioning surgeons inject a dispersive visco- elastic beneath the nasal anterior capsule to better visualize and in- crease the space between the periph- eral endonucleus and the anterior and equatorial capsule. Dr. Oetting said he likes the idea of putting a little trench to help visualize where one should impale especially when getting started. For a pure phaco chop with no sculpting, he advised surgeons start about 2 mm short of the center of the lens and end up in the center or just past the center 100% occluded. "The number one problem that people have while they're getting the chopper into position is let- ting go of the lens with the phaco needle. Usually, as people move in with the chopper, they pull back the phaco needle and lose their grip on the lens. The key is to move forward with the phaco needle as you move the chopper out so you don't lose your grip on the lens. The main thing is you want to be in the area of the epinuclear/nuclear intersection and you want to make sure you're under the capsule," Dr. Oetting said. While horizontal chop is more appropriate for soft to medium lenses, denser lenses are more suited for vertical chop, Dr. Oetting said. When tackling a dense lens, Dr. Chang agreed and said that higher vacuum is much more important to Park, Illinois) and Mynosys (Fremont, California). Drs. Al-Mohtaseb, Oetting, and Zavodni have no financial interests related to their comments. Contact information Al-Mohtaseb: zaina@bcm.edu Chang: dceye@earthlink.net Oetting: thomas-oetting@uiowa.edu Zavodni: zacharyzavodni@gmail.com phaco chop, as well as two surgical case videos presented by Dr. Chang, at www.ascrs.org/center-for-learn- ing/video/phaco-FUN. You will need to register and log in to view this video. EW Editors' note: Some comments have been slightly modified from the webinar for clarity. Dr. Chang has financial interests with Abbott Medical Optics (Abbott increase holding power when chop- ping a dense nucleus. Dr. Zavodni concluded the webinar, offering a word of caution on his final slide: "Things happen in the anterior chamber for a reason. If they're not responding the way you want them to, then change some- thing." Check out the webinar for more details about horizontal and vertical Join Us at AAO Booth 2515 Visitec ® I-Ring ® Pupil Expander A safe and gentle solution for intraoperative small pupil expansion ● Atraumatic ● Protects the iris ● Iris quickly returns to natural shape post surgery Beaver-Visitec International, Inc. 411 Waverley Oaks Road, Waltham, MA 02452 Tel: 1.866.906.8080 Fax: 1.866.906.4304 www.beaver-visitec.com BVI, BVI Logo and all other trademarks (unless noted otherwise) are property of Beaver-Visitec International ("BVI") © 2016 BVI "The I-Ring eases pupillary woes with good folding — unfolding; engaging — disengaging of the iris in small pupil and IFIS cases." — Amar Agarwal, Managing Director of Dr. Agarwal's Eye Hospital and Eye Research Centre, India

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