The placement of the chopper is critically important to achieving division of the cataract nucleus with the phaco chop technique. The two primary principles are (1) to fixate the nucleus so it does not move during the chop maneuver and (2) to engage a sufficient amount of nucleus with the chopper so that we achieve a cleavage plan instead of simply scoring the surface.
The nucleus can be fixated and held still in two primary ways: using a high vacuum setting to engage the nucleus after it is impaled with the phaco tip or we can trap the nucleus between to opposing instruments so that it cannot move. By using both of these techniques in flip-and-chop, we virtually guarantee a successful chop and nucleus division.
Once the nucleus is prolapsed partially out of the capsular bag, a gap is created so that the chopper can be placed behind the central nucleus and directly opposite the phaco probe. This holds the nucleus securely so that the chopper can pull it into the chopper while the surgeon engages the phaco vacuum at the same time to give even more holding power. Now the chopper and phaco probe can be pulled apart, creating a complete division of the nucleus into two halves.
Click below to learn specifics about placing the chopper for flip-and-chop:
Dear Dr Uday Devgan,
With lots of interest i look at your daily submitted videos.
I have a question: by prolapsing the nucleus into the anterior chamber, with a rhexis size of at least 5.5 mm, aren’t you afraid of tearing the rhexis margin?
If not, how do you know for sure that the risk of tearing the rhexis is little?
I generaly use the divide and conquer technic, but managed today luxating the nucleus into the anterior chamber, but it is still a little bit uncomfortable doing so.
Do you have some tips and tricks for me to mastering luxating the nucleus into the anterior chamber, except for watching your videos?
I had a IFIS case today, but was not sure enough to luxate the nucleus into the AC. If i watch your videos you make it look easy and simple..
I hope to hear from you soon.
Kind regards,
Jocelyn Kasanardjo
Thanks for the comments and feedback. Ultimately it is a surgeon’s experience with the technique. Also the softer the nucleus the less critical is the size of the rhexis. Very rare to have a torn rhexis with this technique.