● Capsular opening ○ Capsulorhexis ○ Incision made in cornea ○ Tear circular opening in anterior capsule ■ 1.8mm width is standard ● This would be final entry point ● Central corneal thickness is 500um ● Peripheral cornea is 900um ■ Capsulorhexis ■ Access to natural lens - cataract ○ Red ring = anterior capsule opening Measurement 1.8 mm Width of corneal entry (horizontal) ~0.25–0.5 mm Depth into corneal tissue (vertical) ~1.5–2.5 mm Tunnel length into the anterior chamber ● Hydrodissection ○ Salt solution injected in capsule ■ Helps loosening lens-better removal process ○ Separates cataractous lens nucleus ● ● ● ● ○ Lens may shift must be aware Phacoemulsification ○ Removal of lens ○ Phaco probe will be inserted in lens - insertion in corneal incision ■ Ultrasonic vibration - breaking down lens nucleus ■ Fragments suction through probe ○ Capsular bag = new artificial lens Cortex Removal ○ Removal of remaining soft tissues ■ Lens cortex debris ■ Outer layers ○ Irrigation aspiration tools used = clean capsular bag ○ Left over lens are cleared out ■ Will have postoperative infection which will cause inflammation in eye ■ Capsular bag empty = need artificial lens applied at this stage Intraocular Lens ○ IOL insertions ○ Loaded into injector ■ Injector will insert IOL in capsular bag - using same incision ■ Lens unfolds in capsular bag ■ In position Final adjustments ○ Centering IOL ■ Folded and inserted in injector 2.8-2.8mm cut ■ IOL spews out of injector to support arm -> enters capsular bag => central lens => trailing haptic ■ Will unfold inside bag after insertion ■ OVD injected to capsular bag prior to insertion ● Protect corneal endothelium + open and expand bag ● Secure place for unfolding lens ■ OVD could be added again after lens insertion ● Needed to fix IOL ■ Rotating Toric IOL ● Some patients may need astigmatic correction ● Axis marketing in optic ● Rotation of lese matching astigmatism axis measured in step 1 ● ex) ○ 10 degree misalignment