Tri-soft shell technique.

Soft-shell techniques exist for lower viscosity dispersive with higher viscosity cohesive ophthalmic viscosurgical devices (OVDs) (soft-shell technique [SST]), viscoadaptive OVDs with balanced salt solution (ultimate soft-shell technique), intraoperative floppy-iris syndrome (soft-shell bridge), and many specific modifications for disinserted zonular fibers, frayed iris strands, Fuchs endothelial dystrophy, small holes in the posterior capsule with protruding vitreous, capsular dye use, and others. Soft-shell techniques exist because it is rheologically impossible to control the surgical environment with a single OVD as well as with an ordered combination of rheologically different OVDs. Surgeons frequently confuse these techniques because of their multitude. This paper unifies all SSTs into a single improved tri-soft shell technique (TSST), from which basic specific applications to unusual circumstances are simple and intuitive. As shown with previous SSTs, the TSST allows surgeons to perform complex tasks with greater surgical facility and to protect endothelial cells better than with single OVDs.