For a cataract with moderate nuclear density, splitting the nucleus into two halves can be sufficient for removal with phacoemulsification. There is no need for further subdivision of the nuclear halves into smaller pieces with appropriate phaco power modulation settings and a sufficiently large capsulorhexis of 5 mm diameter or larger.
In this case, a single chop is made to split the cataract into two halves, each of which is the brought up to the iris plane with the phaco probe and then aspirated. The role of the chopper is then to keep the nuclear pieces in front of the phaco probe since no further chopping is required.
This patient also has about 1 diopter of corneal astigmatism with a steep axis against-the-rule (ATR) at about the 20 degree meridian. The main phaco incision is placed temporally at this position and then towards the end of the case with the IOL in the eye, a second, paired, full-thickness incision is made at the nasal limbus at the same 20 degree axis. In this case we are making this extra astigmatic incision with the eye full of saline, not viscoelastic. This means that care must be taken not to let the anterior chamber collapse as the incision is created.
click below to watch the video of this surgery:
