Introduction: Intraoperative fracture of a phacoemulsification tip is a rare complication, and real-time video documentation of such events is scarce in the literature. Patient and Clinical Findings: A 68-year-old female patient with moderate pseudoexfoliative glaucoma and a brunescent cataract was scheduled for combined gonioscopy-assisted transluminal trabeculotomy (GATT) and phacoemulsification in the right eye. Diagnosis, Intervention, and Outcomes: GATT was completed uneventfully, and phacoemulsification was then initiated using a stop-and-chop technique. During emulsification of the final nuclear fragments—using 80% torsional ultrasound, 400 mmHg vacuum, and 40 cc/min aspiration—the distal portion of the tip fractured. The fragment remained trapped within the sleeve and fell onto the surgical drape after withdrawal of the handpiece. The tip was replaced with a new one, and surgery continued without further complications. The posterior capsule remained intact, and no intraoperative or postoperative sequelae were observed. Conclusions: Prompt recognition of phacoemulsification tip fracture allows safe retrieval of the fragment and continuation of surgery. Real-time video documentation provides an educational reference for understanding the mechanism and management of this rare complication.
Gustavo Carvalho Pavão (Thu,) studied this question.