This is a cataract surgery performed by a resident in training and the patient is known to have Fuchs’ corneal dystrophy, where there is endothelial cell drop-out and declining function. We have previously explained how to evaluate these patients and successfully perform cataract surgery while preserving the endothelial cell function.

Pre-operatively, this patient had a central corneal pachymetry of 600 microns and an endothelial cell count of about 1000 cells per square millimeter. We used plenty of dispersive viscoelastic to protect these cells during the cataract surgery and we employed phaco power modulations to limit the ultrasonic energy.

This resident is still learning and at this point is most comfortable with a divide-and-conquer or stop-and-chop approach to nucleus removal. The sculpting of the central grooves in these techniques will require a significant amount of ultrasonic energy and we want to avoid that. To assist, I simply used the chopper in combination with a 27-gauge blunt cannula to chop the nucleus into halves. Of course, this requires zero phaco power, and the technique is relatively easy as long as you understand the force vectors and how they are applied. The patient did great and had a clear cornea on the first post-op day.

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