Sometimes cataract surgery is like playing basketball or soccer: you know many different techniques and special moves, but the key is knowing when to use each one. And sometimes the best approach may be using more than one technique or using a combination technique. This surgery starts out with an attempt at vertical phaco chop but that does not succeed in producing two separate hemi-nuclear pieces because the nature of the cataract is more fibrous. The solution here is to switch to horizontal chop where we use the chopper to hook the lens equator and then propagate the chop.
Vertical Chop:
- both instruments, phaco probe and chopper, are within the central nucleus
- no need to advance chopper under the capsulorhexis edge
- action is splitting the nucleus from anterior to posterior
Horizontal Chop:
- phaco probe in the central nucleus, but chopper is placed around lens equator
- chopped must be advanced under the capsulorhexis edge
- action is splitting the nucleus laterally from outer edge to central nucleus
Click below to see this transition from Vertical Chop to Horizontal Chop:
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