Prof. Dr. Ahmed Assaf

04/06/2026

White Cataract Series 🤍
Episode 3B: Vertical Chop

For this dense white cataract, Intelligent Phaco (IP) on the Centurion was activated.

IP delivers short bursts of longitudinal ultrasound, improving followability, enhancing cutting efficiency, and helping keep nuclear fragments attracted to the phaco tip.

The phaco tip is then deeply embedded into the center of the nucleus to achieve a firm purchase. The Nuyhan chopper is positioned adjacent to the phaco tip and driven vertically downward, separating the nuclear fibers.

The nucleus is then manually split into two halves, creating smaller fragments for safer and more efficient emulsification.

A firm hold.
A decisive chop.
A complete split.

30/05/2026

White Cataract Series 🤍
Episode 3A: Horizontal Chop

There is more than one way to tackle a white cataract.

In this case, I chose a horizontal chop technique.

After hydrodissection, the nucleus is gently rocked to ensure free mobility. With the phaco tip in the right hand and a Nagahara chopper in the left, high vacuum is key.

A central pit is created, the nucleus is firmly engaged, and the chopper is passed around the equator then pulled toward the phaco tip, creating a complete split.

The process is repeated to divide the nucleus into smaller fragments, reducing ultrasound energy and helping protect the corneal endothelium.

Pearls:
• High vacuum
• Stable anterior chamber
• Well-dilated pupil
• Complete chop, not forceful chop

28/05/2026

White Cataract Series 🤍
Episode 2: The Rhexis

Before starting the rhexis, as much liquefied cortex as possible is aspirated to decompress the bag and reduce the risk of a runaway tear.

The rhexis is intentionally started small.
In these cases, confidence comes gradually… as the direction of the tear becomes more predictable.

Once control is gained, the rhexis is enlarged carefully in a spiral fashion.

A few important details throughout the maneuver:
• Keep the OVD cannula ready in the left hand at all times
• Leave the flap centrally within the anterior chamber to maintain control

The goal is a controlled 5 mm rhexis without extension.

In white cataracts, every millimeter matters

22/05/2026

White Cataract Series 🤍
Episode 1: The Air Bubble

In white cataracts, visualization is everything.

Trypan blue is first injected, followed by air through the side port.
Then additional stain is injected under the air bubble to achieve a more uniform staining of the anterior capsule.

That air bubble doesn’t just trap the dye…
it helps create a clearer, more controlled view before the real challenge begins.

In these pressurized lenses, every small detail matters

21/05/2026

16/05/2026

Same eye. Different tear film …
This young cataract patient underwent IPL and dry eye treatment BEFORE toric IOL planning.
Post-treatment iTrace showed:
• improved CPI & QVI
• reduced corneal HOAs
• more reliable measurements