I think this maneuver is under-utilized. When I am faced with a shallow anterior chamber with significant positive pressure, and I am having some trouble just getting my instruments in the eye, then I bite the bullet. Instead of trying to inject more and more viscoelastic,  I take down conjunctiva, enter the pars plana at 3.5mm from the limbus, and either the liquified vitreous pours out, or I do a very quick (1 minute) vitrectomy. Immediately, the AC is deep and the eye is soft (don’t take out too much vit, or the eye will be too soft), and the phaco becomes an absolutely routine case. I don’t have to worry about my rhexis running away, or my posterior capsule coming up at me. I have done this only three times, and each time it saved the day. I know that Dr. Fine in Oregon is a big advocate of this. Close the sclera with a 7-o vicryl, and just look at the fundus the next day to make sure nothing funny happened.

This maneuver is very easy, and even low-volume guys like me can do it. Trust me- you’ll be grateful.