It was 1998 (I know, a long time ago) and I was fortunate to get a VHS tape of Dr Robert Osher’s Video Journal of Cataract Surgery and I saw the technique of Phaco Chop. Wow, I was truly in awe and while my professors were teaching me divide and conquer (for which I was very appreciative), I just could not believe how much more elegant phaco chop was. I was determined to learn it and I did, during my residency. You can also learn this. In fact, you must learn it.
In 1995, Dr. Kunihiro Nagahara introduced the phaco chop technique as a revolutionary method for nuclear disassembly during cataract surgery. Unlike traditional divide-and-conquer, which requires sculpting deep grooves in the nucleus, phaco chop relies on mechanically cleaving the nucleus using two instruments: the phaco tip to hold the nucleus with high vacuum and a chopper to split it. Nagahara’s approach reduced phaco energy, minimized corneal endothelial damage, and increased efficiency, particularly in dense nuclei. In his original presentation, he emphasized the importance of high vacuum settings to achieve nucleus purchase and precise instrument coordination to achieve a clean crack with minimal ultrasound power. This technique marked a shift toward microincisional, energy-efficient cataract surgery, influencing modern phaco strategies worldwide.
