With a dense cataract, more effort and force is needed to chop the cataract. Usually with phaco chop, it is the high vacuum level that holds the nucleus as the chopper creates a fracture in the lens nucleus. With a dense cataract, this 400 to 500 mmHg of holding power may not be enough and it becomes helpful to trap the nucleus between the phaco tip and the chopper. Then more force can be applied to break the nucleus into smaller pieces using the chop technique.
This video is from Dr. Anant Vir Jain MS from Ghaziabad, India and he shows a technique of first drilling a hole into the sub-incisional nucleus, then rotating the nucleus 180 degrees, and finally performing the chop with the instrument placed inside this drill hole. We have seen variations of this technique over the past many years, and we are appreciative of Dr. Jain’s version. We could achieve something similar in terms of trapping the nucleus to apply force by using the horizontal chop technique with the tip of the chopper placed at the equator of the cataract nucleus. An advantage of the drill and chop technique is that the chopper can be placed in this hole which is within the confines of the capsulorhexis. There is no need to place the chopper tip under the capsulorhexis and push it out towards the cataract nucleus equator, which is a move than many beginning surgeons find challenging.
click below to learn this technique of drill and chop for dense cataracts: