Should we chop in the bag or above the bag?

Should we chop the nucleus within the capsular bag or should we bring the nucleus partially out of the capsular bag before chopping? There are advantages to each.

Chopping in the capsular bag allows us to keep the phaco energy away from the corneal endothelium but makes it challenging to split a dense posterior nuclear plate. It also requires that the zonular apparatus be sufficiently strong to support the nucleus during these maneuvers.

Chopping above the capsular bag allows us to access a dense posterior nuclear plate with the chopper but requires a sufficiently large capsulorhexis (5 to 5.5 mm in diameter) in order to bring the nucleus out and above the anterior capsular rim.

So which would you choose? Watch the video below to see both techniques:

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