Capsulorhexis and phaco of a very dense brunescent cataract without damaging the cornea.

How to phaco a dense brunescent cataract without damaging the cornea.
1) Create a deep trough until a dull ROR is seen.
2) Remove as much of the dense nucleus in the bag, away from the cornea. 3) Break the cataract into small manageable pieces that can be easily manipulated in the anterior chamber. Make sure to break the tough posterior plate of the cataract as well.
4) Mash the fragments against the phaco tip using the second instrument
5) Apply as little ultrasound as needed to emulsify the dense fragments.
6) Emulsification sequence:
a) use vacuum to hold the fragment against the tip
b) mash the fragment against the tip using the second instrument
c) blip the pedal to emulsify the fragment
d) repeat until all fragments are emulsified

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