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Aim
A freely mobile nucleus.
Decompressed posterior capsular compartment which may be pressurized due to retro-lenticular and intra-lenticular gas.
Principles
“Burp” the incision site slightly to let out some of the viscoelastic. Do this with gentle pressure on the posterior lip of the incision with the capsulorhexis forceps once the capsule has been removed from the eye. I don’t rush this step to allow for the pressures in the eye to equilibrate and avoid the lens or iris moving too anteriorly.
Sweep your hydrodissection cannula under the capsule in two separate areas for at least 2 clock hours to separate any capsular-cortical adhesions which would prevent the fluid wave propagating back into the anterior chamber.
Having a mobile nucleus makes the rest of the operation easier, and rotating it will also free up more of the cortical material making aspiration easier.
I find that rocking the lens to move the retrolenticular gas around behind the nucleus frees up any adhesions and allows for a more mobile nucleus.
Tip
If there is retrolenticular gas and a hard large nucleus, consider venting the gas by cracking the nucleus before hydrodissection. Alternatively sweep under the capsule edge with the irrigation cannula for more than 3 clock hours and then proceed as per manual cataract surgeon.