While performing horizontal chop, this resident inadvertently places the Seibel on top of the anterior capsule, chopping the anterior capsular tear and causing zonular dehiscence.
Tips:
1. As discussed in the video, placement of the phaco probe tip should be more subincisional, to allow the horizontal chopper to propagate a longer crack through the nucleus.
2. The most important consideration after anterior capsular tear is avoiding posterior extension.
3. Cortex removal should start away from the region of the tear, leaving the area of zonular dehiscence for last.
4. Manual cortex removal can also be performed with a 27 gauge cannula.
5. If possible, the lens haptics should be positioned away from the tear.
6. Patients should be carefully observed in the post-operative period, as the epinuclear pieces in the vitreous can result in increased inflammation.
7. When learning horizontal chop, it is helpful to stain the capsule with trypan blue to better visualize the anterior capsule.
