Surgical options in the face of positive pressure

Positive pressure during cataract surgery can adversely affect the clinical outcome if the surgeon is unprepared. A variety of surgical maneuvers are described, including dry insertion of the phacoemulsification needle, capsule protection with the second instrument, dry cortical aspiration in an ophthalmic viscosurgical device (OVD) environment, intraocular lens restraint with an injection cannula at the end of OVD removal, aspiration or vitrectomy through the pars plana, a technique of OVD clearance to manage extreme cases of positive pressure, and intraoperative ophthalmoscopy using a lens designed to function with the operative microscope. Mastery of these important surgical maneuvers will help the surgeon manage challenging cases of positive pressure.