Rotary Chop: A New Technique for Teaching Chop and Tackling Mature Cataracts

Abstract

Introduction: Here we describe a new cataract chop technique that is most valuable for two groups of ophthalmologists: (1) experienced surgeons encountering challenging nuclear fragmentation due to mature cataracts or zonulopathies, and (2) inexperienced surgeons wishing to develop skills necessary for chopping techniques. Methods: We have termed this new method ''rotary chop,'' since the partial thickness pilot holes created by the phacoemulsification (phaco) tip around the periphery of the nucleus produce a rotary phone dial appearance on the surface of the cataract. By creating these pilot holes, the surgeon is able to easily place the chopper deep into the body of the nucleus, avoiding the need to apply vertical piercing force to the nucleus. Results: The patient in the technical video had a 4? nuclear sclerosis cataract. The preoperative vision in this eye was counting fingers at 2 feet with no improvement with refraction. On postoperative day 1, visual acuity had improved to 20/80. By postoperative week 1, best-corrected visual acuity was 20/20 (20/25-2 uncorrected). Conclusion: This method avoids unnecessary zonular stress. Additionally, inexperienced surgeons using this technique during routine cataract surgery are able to quickly master the movements necessary for both vertical and horizontal chop in a safer environment.

Drill-and-Prechop Technique: Modification of the Drill-and-Crack Technique for Mature Cataracts

“…The drill-and-crack technique, introduced by Hwang HS et al [13] involves a deep hole in the central nucleus with the phaco tip and divides the nucleus with the prechopper inside the hole. Different from the consecutive drilling combined with the phaco chop technique[6] and rotary chop [17], it only drills one deep, narrow hole near the geometric centre of the endonucleus which could decrease the ultrasound energy. It offers easy and effective nuclear disassembly in patients with a hard nucleus cataract.…”

“…It combines the advantages of phaco-chop and phacodrill [15]. Rotary chop introduced by Ifantides C et al [17] created two or more partial thickness pilot holes around the periphery of the nucleus by the phaco tip. Then, tackle the nucleus with the chopper and phaco tip in two holes in a meridian.…”

“…The absence of a protective epinuclear layer, the paucity of cortex, the fragility of the capsule, and the laxity of the zonules increase the risk of injury to the supportive structures of the lens during surgery [1]. Many techniques for hard cataracts have been described: step-by-step chop in situ [2], crater-and-chop technique [3], drill and chop [4], multilevel chop technique [5], terminal chop [1], consecutive drilling combined with phaco chop [6], and rotary chop [17]. To minimize the ultrasound energy in phacoemulsi cation, many prechop techniques have been described [6][7][8][9][10][11].…”

Drill-and-prechop technique: modification of the drill-and-crack technique for mature cataracts

“…It combines the advantages of phaco-chop and phaco-drill [ 15 ]. Rotary chop introduced by Ifantides C et al [ 7 ] created two or more partial thickness pilot holes around the periphery of the nucleus by the phaco tip. Then, tackle the nucleus with the chopper and phaco tip in two holes in a meridian.…”

“…The absence of a protective epinuclear layer, the paucity of cortex, the fragility of the capsule, and the laxity of the zonules increase the risk of injury to the supportive structures of the lens during surgery [1]. Many techniques for hard cataracts have been described: step-by-step chop in situ [2], craterand-chop technique [3], drill and chop [4], multilevel chop technique [5], terminal chop [1],consecutive drilling combined with phaco chop [6], and rotary chop [7]. To minimize the ultrasound energy in phacoemulsification, many prechop techniques have been described [6,[8][9][10][11][12].…”