Incision site does not line up with capsulorrhexis
If the eye was tilted when docked, the capsulorhexis may be para-central but the main incision and secondary port do not line up radially with the center of the capsulorrhexis.
The resulting problems:
• The incision in the cornea is started obliquely and may not enter the eye in a uniform plane.
• The phaco tip is guided towards an eccentric position in the eye.
Management
Use a blade to make the sideport if the incision does not enter the anterior chamber.
Continue to use the main incision as it is possible to finish the operation, but bear in mind that the tubing may be compressed if the phaco tip is angled centrally.
The main incision does not open
Arcus or corneal scarring does not allow the laser to cut through the cornea from epithelium throught to the anterior chamber
The resulting problem
There will be difficulty opening the incision and vigorous attempts will cause an epithelial abrasion
Management
Initially I was hesitant to make an incision with a blade through a partially cut laser incision and moved my incision so that it would not touch the initial laser cut. This has proved to be unnecessary and I now just start a new manual incision slightly limbal to the laser incision. There has been no wound leakage or damage to descement’s membrane.
Similarly, side port incisions can be made with a blade if the side port laser created incisions is difficult to find or open.