Under topical anesthesia, there are some patients who have a difficult time holding still during critical parts of the surgery such as capsulorhexis creation. We can give additional anesthesia, either local agents such as a retrobulbar block or systemic sedation. Another great option is to fixate the eye by hooking the paracentesis incision with the chopper.
This technique will hold the eye still during capsulorhexis creation. Then once phacoemulsification begins, the eye is far more stable because there will be continual two point fixation via the chopper in the paracentesis and the phaco probe in the main incision.
click below to see two cases where we use the chopper to fixate the eye: