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The use of a second instrument during phacoemulsification: does it really protect the posterior capsule?
  1. J Tee,
  2. A Shah,
  3. B C Little
  1. Department of Ophthalmology, Royal Free Hospital, London, UK
  1. Mr B C Little, Department of Ophthalmology, Royal Free Hospital, London NW3 2QG, UK; brianlittle{at}

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The technique of placing a second instrument between the posterior capsule and nuclear fragment is generally encouraged because it intuitively provides added protection against capsule aspiration and rupture by the phaco tip.1 2 This is especially so when the last segment is being phacoemulsified.

However, it has been shown in our recent study3 that significant leakage occurs via a side-port incision when a second instrument is used through it. In fact the majority of fluid used during phaco appears to be lost through wound leakage, and a significant proportion of this is through the second instrument sideport. This inevitably contributes to chamber destabilisation and posterior capsule fluctuation, and it follows that the risk of capsule aspiration is likely to be increased. Logically, therefore, chamber fluctuations and the chance of posterior capsular damage should be reduced if …

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  • Competing interests: None.

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