There are many techniques for breaking up the nucleus and aspirating it with the phaco probe and ultrasonic energy. And a great surgeon should learn all of the techniques so that for each specific patient, the best choice can be made. If your only technique is divide and conquer, then how will you remove the cataract when it is all posterior sub-capsular with minimal nuclear sclerosis? For many of my patients, I prefer this tilt and chop technique where the nucleus is partially tilted out of the capsular bag and then safely and efficiently chopped into small pieces where are easily phaco-aspirated. This gives a very high degree of safety since we are not chopping in proximity to the posterior capsule. And it is very efficient and induces minimal post-op inflammation. Have you tried this technique? Please comment below.
Yes sir. I have been doing this technique for past 16 years
I do it for grade 3 & 4 as well, albeit one has to be extra careful while holding the nucleus on high vacuum and must have a sharp and pointed chopper to impale the nucleus at a point exactly opposite the point where phaconeedle holds the nucleus. Sometimes in brunescent cataracts the hemi fragments do not separate entirely but have elastic like connection between them. One needs to completely separate them manually before going for further chopping. All in all a very safe technique. I used to call it flip and chop