Current status of and factors influencing advance care planning participation among adolescents and young adults with cancer: a mixed-methods systematic review.

The removal of the epinucleus represents a technically demanding phase of modern phacoemulsification cataract surgery. As the transitional layer between the dense nucleus and soft cortex, the epinucleus exhibits variable biomechanical properties that complicate its extraction []. While the nucleus can often be efficiently fragmented and aspirated, the epinucleus poses unique difficulties due to its variable thickness, adherence to capsular bag, and proximity to the fragile posterior capsule []. Improper manipulations during epinucleus removal may precipitate serious complications such as posterior capsular rupture [, ]. Conventional strategies for epinucleus removal present distinct limitations. The use of phaco tip, while efficient for nuclear fragmentation, carries inherent risks when applied to epinuclear extraction. Inadvertent ultrasound activation may lead to rupture of the posterior capsule, particularly when manipulating a thick and adherent epinucleus. Conversely, sole reliance on irrigation/aspiration (I/A) tip, though theoretically safer, often proves inefficient and time-consuming []. In this report, we introduce the Phaco Tip-Chopper Flip Technique, an integrated approach combining the aspiration efficiency of phaco tip with the mechanical advantages of chopper-assisted epinucleus manipulation. The coordinated action enables safe and efficient epinuclear detachment and removal. We retrospectively observed 16 eyes that underwent this technique and report the preliminary clinical outcomes.