I encourage ophthalmologists in training to learn multiple different nucleo-fractis techniques so that they can tailor the cataract surgery to each individual eye. While my favorite technique tends to be a quick combo-chop which splits the nucleus into two halves immediately, I am comfortable doing all different types of nucleus division. If are comfortable with just the divide-and-conquer technique, you will find yourself in a bind when presented with various challenging cases.
In the video presented here, I quick chop the nucleus into two halves and then attempt to bring one half out of the capsular bag. But it does not work because either the nuclear piece is too big or the capsulorhexis is too small. At this point, I simply rotate the nucleus and then chop each half again, thereby netting four quarters, each of which is easily brought up to the iris plane and phaco-aspirated.
