Phaco Flip and Chop Technique

The phaco flip technique is when the nucleus is prolapsed out of the capsular bag and then emulsified at the iris plane. The advantage is that it brings the nucleus away from the posterior capsule and thus can provide a margin of safety. But using solely phaco energy to emulsify the entire nucleus in the iris plane can amount to a large amount of ultrasonic energy and that could end up causing corneal endothelial damage.

The idea behind phaco flip and chop is to bring the nucleus partially out of the capsular bag and then use the chopped to manually disassemble the nucleus into smaller fragments which can then be removed with significantly less ultrasonic energy. That gives us the advantage of being away from the capsular bag while providing the efficiency and low energy levels of the chop technique.

This patient is a professor from a large university who traveled to Los Angeles to have cataract surgery with me. We aimed for a post-operative target of about plano and we also addressed his 1 diopter of against-the-rule astigmatism. We did this by placing our phaco incision (2.75 mm) at the 180 degree steep axis and then performing an opposite limbal relaxing incision in the same meridian.

Take a look at the video which is provided unedited and with running narrative to maximize learning.


The above video, which was filmed yesterday, shows a complete case in about 6 minutes. The specific timing is not important since we are not in a race. Our goal is efficient, safe, and minimally-traumatic surgery, so we focus on the task at hand and make each movement purposeful.

For those with great memories, you may recall a video of mine from 12 years ago where I used phaco flip and chop to maximize efficiency and routine did cataract surgeries in about 3 to 4 minutes. That was also good, but chasing a fast time is not what we want. Take your time and do a beautiful and safe surgery — don’t worry if it takes a few extra minutes. The patient will be happier if you relax, take your time, and do a great job.

Above is the old video from 2006 showing the technique that I used many years ago. And this was before high-definition ophthalmic microscope cameras, so the video quality is lower (640×480 pixels).