Once the nucleus is removed from the anterior chamber, there remains the epinucleus. This is a shell around the nucleus and usually comes along with the nucleus. Rarely the epinucleus has to be removed separately. Once the anterior chamber is free of nucleus and epinucleus, the chamber is again reformed with viscoelastics, and cortical cleanup is begun. This step needs to be done with utmost gentleness and care. Some surgeons prefer to use a 5 cc/2 cc syringe with a cannula filled with balance salt solution to irrigate the cortical matter before removal. This helps to loosen the cortex from the capsule and facilitates easy removal. This can be done through the main incision or the paracentesis. During small incision cataract surgery, the best available tool for cortical cleanup is the Simcoe cannula. The most accessible parts of the eye are tackled first, such as the inferior 3–4 clock hours. A side port incision at 3 o’clock helps in aspirating cortex from the 9 o’clock region, and the 3 o’clock region can be accessed via the superior main port if one is operating from a superior incision. The side port not only helps to reform the chamber at the end of the surgery but also helps to aspirate cortex from the subincisional region. Alternatively a J-shaped cannula can also be used for removal of subincisional cortical matter.

The cortex material is a loosely adherent covering around the nucleus and the epinucleus, and it consists of 2 leaves with the body adherent to the fornix of the bag. The principle of cortex removal is to gain purchase of the anterior leaf of the cortex and tear it away from the capsule in such a manner that it peels off from the rest of the capsule. Traditional teaching has been to gently tear the anterior cortex perpendicularly to the centre of the eye away from the fornix of the capsular bag. The idea being 60–90° (one quadrant) of cortex is removed in one attempt (see Fig. 1). Once the anterior leaf of the cortex is held, then side-to-side motion of the Simcoe cannula helps in stripping the cortex from the capsule (see Fig. 2). A more efficient method would be to gain purchase of the anterior leaf of the cortex and pull downward towards the posterior capsule (but not towards the centre of the eye) gently tearing the cortex away from the anterior capsule and in this way not putting too much stress on the zonules in the periphery of the capsular bag (see Fig. 3). This technique is very useful in eyes with pseudo-exfoliation syndrome and eyes with angle-closure glaucoma with inherent weakness of the zonules.