The Stop-and-Chop technique for nucleus removal during cataract surgery blends aspects of the Divide-and-Conquer method with some Phaco Chop. Some surgeons use it as a stepping stone before moving to full chop techniques. Others stick with doing stop-and-chop for their entire careers.
The surgeon behind Stop-and-Chop is Paul Koch MD from Rhode Island, USA who coined both the term and the technique in 1994. The idea is to make a central groove in the nucleus and crack it into two hemi-sections, then instead of proceeding to more grooving as with the divide-and-conquer technique, you “stop and chop” the nuclear halves.
“The procedure begins as a routine nuclear cracking technique and then stops. It continues as a chop technique.” — Paul Koch MD
For this technique, it is critical that the capsulorhexis is of sufficient size, at least 5 mm in diameter. For Divide-and-Conquer a smaller capsulorhexis can be used since each of the four quadrants is smaller than the two nuclear halves in Stop-and-Chop.
One key to remember is that the depth of the initial groove needs to be more in softer cataracts in order to propagate the complete cracking of the posterior plate. But the deeper the groove, the closer you are to the posterior capsule.
I think that stop-and-chop is a better technique than divide-and-conquer, and it’s a good stepping stone toward doing a completely phaco-chop technique. If you are a new surgeon who is learning various methods of nucleus removal, stop-and-chop is a great “go-to” technique for most cases and also a great “fall-back” procedure you are unable to achieve the phaco-chop maneuver in a particular case.
Click below to see me perform Stop-and-Chop:
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