Using this technique no laser light is being emitted into the eye because the lens material is emulsified indirectly. The nano laser is effective for lenses with grade 1–4 nuclear sclerosis (LOCS-classification).

Nano laser photofragmentation and ultrasonic phacoemulsification are two physically completely different techniques, resulting in different conditions during surgery.

The holdability of the lens particles in the phaco procedure is superior to the nano laser because the laser induced cavitation out of the port and the aspiration in the opposite direction are always competing with itself. The holdability has been improved by shortening the nano laser pulses. The deep impaling necessary for an efficient chopping technique is not possible because the laser handpiece is missing the phaco oscillations.

In clinical practice two different techniques for the removal of lens tissue proved to be effective.

Softer nuclei (LOCS 1–2) can be removed with a so called bowling technique. The lens nucleus is photo fragmented by slightly rotating the tip down posteriorly from the middle of the surface. The tip is positioned with the port bevel down to protect the corneal endothelium. The epinucleus and cortex need to be untouched in order to protect the posterior capsule. For harder cataracts a lower frequency of laser pulses should be used. After the removal of the nucleus the epinucleus and cortex can be aspirated with the standard I/A.

Harder cataracts (LOCS 3–4) can be more efficiently emulsified by a “groove & crack” technique. Again with port bevel down a small hole or a little grove is created in the lens center up to approximately 50 % of the lens thickness. Then the lens nucleus can be cracked with a second instrument, for example an iris hook or a Neuhann chopper. With aspiration half of the lens can be elevated in the iris level to fragment the half completely. If possible the same technique can be used to produce four quadrants. After removal of the nucleus the cortex and epinucleus are aspirated.

The complete nano laser cataract surgery is performed with single use instruments and thus features a very high hygienic standard.

The theoretically expectation and advantage of the laser photofragmentation over phacoemulsification are the lesser induction of shockwaves resulting in a gentler effect on corneal endothelium and intraocular tissue.