Nucleus removal technique dubbed ‘daisy de-petalling’

COSTA DO SAUIPE, Brazil — Breaking hard nuclei into “petal-like” sections and aspirating one at a time may be a viable alternative to other techniques, said Newton Kara José, Jr., MD. Dr. José described the technique, which he dubbed “daisy de-petalling,” here at the Brazilian Congress on Cataract and Refractive Surgery.

“In hard nuclei, the greatest challenge is the fibrous posterior plate, a leather-like plate between the cortex and the posterior capsule that won’t tear, won’t be fractured with the rest of the nucleus,” Dr. José said.

Using traditional techniques, the surgeon “will only be able to remove the anterior part [of the nucleus], but the posterior portion will not fracture and will remain stuck, especially the center of it,” he said.

Dr. José approaches these problematic nuclei by using the chopper to break the outer part of the nucleus into petal-like sections and then aspirate them one at a time. The chopper, used as a sickle in horizontal motions, will eventually free the posterior portion, he said.

“The chopper does most of the work; the phaco tip stays in the safe central zone, mostly holding the fragments with its suction power,” he said. After the petals are aspirated, the surgeon can more easily remove the posterior plate.

Surgery becomes easier when the surgeon defines a specific technique and sticks to it throughout the procedure, he said.

“You need to be patient and make sure you use as much viscoelastic as necessary. I know techniques are very personal, but if you use this one, the nucleus won’t seem so hard,” Dr. José said.