The Crack and Stack method is the newest of all techniques of performing supra -capsular cataract surgery. It is a safer alternative and much less daunting than traditional supracapsular phaco, most notably the "Phaco Flip" technique.

The Crack and Stack's reproducability for all types of cataracts ranging from the softest cataracts to the 4+ nuclear sclerotic cataract allows the surgeon to approach each and every cataract using the same method with a greater degree of confidence and optimism in the final result. It's high degree of predictability makes it a more efficient method in that it greatly reduces phaco time and minimizes the typical complications such as cornea edema which is inherent in most supracapsular techniques, and capsular tears which result from intracapsular surgery.

The Crack and Stack method of supracapsular surgery is a major improvement from popular intracapsular techniques such as the "Divide and Conquer" method, because it frees the entire nucleus of the cataract from internuclear and epinuclear adhesions, allowing free range of motion of the entire cataract, and allowing phaco to be performed in the safer interpupillary zone of the eye instead of directly on or above the posterior capsule.

The Crack and Stack Method begins with the traditional temporal clear corneal incision along with a paracentesis for the second instrument. Next viscoelastic is inserted into the anterior chamber and a slightly larger than usual capsulorrhexis is made (5.5 to 6.0 mm.). Hydrodissection is performed as usual.

Following these initial steps, there are four easy steps using the pneumonic: Groove it, Crack it, Move it, Stack it.

Step 1, Groove it: The method starts by making a deep groove in the center of the nucleus.

Step 2, Crack it: The second step introduces the second instrument called the Anthone Enabler, which easily helps crack the nucleus into two seperate pieces.

Step 3, Move it: The third step consists of rotating the entire nucleus 90 degrees. This helps break up any remaining epinuclear adhesion and orients the two halves of the nucleus horizontally to the wound.

Step 4, Stack it: In the fourth step, the phaco tip is placed on top of the middle of the proximal half of the nucleus. Using foot position 0 (no irrigation), slide the proximal piece with your phaco tip forward toward the distal piece, which then folds over and stacks onto the proximal piece in an inverted position. The Anthone Enabler is then used to keep the two pieces stacked on top of each other as you engage the foot pedal to position 1 (irrigation), which helps put downward pressure on the top piece. Next, simply phaco the top piece (which is entirely movable and in the safe zone between the Iris boundaries, well below the cornea, and protected below by the proximal piece,making it virtually impossible to phaco the capsule. the bottom piece is also freely movable and easily phacoed after the first half is removed.

The other advantage to stacking the two pieces, is that it always allows the surgeon to see the red reflex in front of and behind the cataract, allowing awareness of the entire cataract and providing phacoemulsification to be performed in the middle of the pupil at all times.

As the surgeon becomes more proficient in this method, he will feel confident in patients with less dilated pupils and smaller (3.5 mm) capsulorrhexis.