Phacoemulsification of the rock-hard dense nuclear cataract: Options and recommendations

J Cataract Refract Surg. 2018 Jul;44(7):905-916. doi: 10.1016/j.jcrs.2018.03.038. Epub 2018 Jun 28.


We describe the essential steps in the successful phacoemulsification of the rock-hard, dense cataract. Appropriate and directed preoperative history, physical examination, and diagnostics allow the surgeon to select the best incision, anesthesia, and intended surgical technique for a given dense nuclear challenge. Hard nucleus-specific approaches for hydrodissection, pupil management, and zonular protection then allow the surgeon to approach the rock-hard nucleus with maximum safety. Dense nuclear dismantling options are then discussed in detail along with fluidic and power modulation considerations. Various specific phacoemusification machine settings for rock-hard cataracts from the authors representing several different phaco systems are then presented. The combination of these steps and considerations allow a more successful dense cataract removal and potential restoration of vision for patients. This paper represents the collective experience and advice of the Challenging and Complex Cataract Surgery Subcommittee.

Publication types

  • Review

MeSH terms

  • Capsulorhexis / methods
  • Cataract / congenital*
  • Cataract / pathology
  • Humans
  • Phacoemulsification / methods*
  • Vision Disorders / rehabilitation

Supplementary concepts

  • Cataract, Nuclear Total