We have all experienced it: a nucleus that it too soft and gummy to divide in the capsular bag and so we keep bowling it out until we are left with this challenge. The nuclear shell is in the capsular bag, very close to the posterior capsule, and there does not seem to be a good way of bringing it out. This is a common situation early in the careers of young ophthalmologists, but it can happen to any cataract surgeon.

If you are stuck in this situation with a bowled out nucleus, there are a few techniques that can help. We can perform additional hydro-dissection (or visco-dissection with a dispersive OVD) to bring the nuclear shell out of the capsular bag, or we can apply vacuum (without phaco power) to the rim of this bowl to bring it centrally and then into the iris plane.

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