This combo chop is a mix of horizontal and vertical chop and it has become my go-to technique for phaco chop within the capsular bag. In some cases, I like to partially bring the nucleus out of the bag and then chop it (tilt and chop) or even flip the nucleus prior to chop (flip and chop). For horizontal chop we place the chopped under the anterior capsular rim and then around the lens equator. The phaco probe is placed just inside the sub-incisional capsulorhexis then embedded so that the vacuum power hold the nucleus still as the chopper is brought towards the phaco tip. This splits the nucleus efficiently. For vertical chop, the phaco probe is placed in the same position just inside the sub-incisional capsulorhexis and then a sharp tipped chopper is placed just in front of it and embedded into the nucleus. The chopper is moved laterally in one direction while the phaco tip is moved in the other. The action is much like chopping firewood and the nucleus can be split efficiently. Combo chop uses a hybrid of both techniques and it really facilitates nucleus disassembly while maintaining a high degree of safety since there is no need to go under the anterior capsular rim, out to the lens equator. It’s a fun technique and quite useful so I encourage you to learn it and add it to your toolbox.
