The original phaco chop technique described by Dr. Nagahara in 1995 was the horizontal chop. This involves holding the lens … More
Category: Phaco Chop
Evaluation of a resident chop technique
This video was submitted by a resident in Asia who is still learning phaco and has upgraded to using the … More
Guest Surgeon: Phaco Chop Technique
This video was anonymously submitted by an experienced surgeon who wants us to analyze the phaco chop technique and give … More
Pre-Chopper Phaco Technique
There are many different ways to divide the nucleus during cataract surgery. Phaco of smaller nuclear fragments is easier and … More
Use the Chopper to Lift Nuclear Pieces Up
In cases where the capsulorhexis is small or where the nucleus is particularly large, it can be difficult to bring … More
Review: Embed the phaco probe without ultrasound
The classic teaching for phaco chop and quadrant removal is to embed the phaco probe into the nuclear piece by … More
Phaco Chop without using the phaco probe
This is a cataract surgery performed by a resident in training and the patient is known to have Fuchs’ corneal … More
Achieving a complete hemi-nuclear split
When performing any nucleo-fractis technique, it is imperative that the nucleus be completely subdivided prior to removing the halves, quadrants, … More
Quiz: For a pupil like this, what is your approach?
With time, young ophthalmologists develop surgical judgment and they are able to look at a case and decide what approach … More
Phaco Flip & Chop is great for Beverly Hills Cataracts
Often, the density of the nucleus and the severity of the cataract relates to the patient’s access to healthcare. In … More
Review: if the chop fails, revert to stop and chop
Sometimes we attempt to use phaco chop to divide the cataract nucleus, but we are just not able to achieve … More
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 … More
The Chop will not propagate through the cataract
With a dense cataract, a fibrous posterior plate can develop within the lens nucleus. This makes is challenging to split … More
Vertical Chop & Horizontal Chop in the same case
Phaco chop is my preferred method of nucleo-fractis for cataract surgery. It is safe, efficient, and minimally invasive, significantly reducing … More
Tilt and Chop – a SupraCapsular Technique
Supracapsular phaco techniques are in closer proximity to the corneal endothelium, which can be damaged by the ultrasonic energy from … More
SupraCapsular Technique for Softer Nuclei
For a relatively soft nucleus, such as in a younger patient with primarily posterior subcapsular cataract changes, the supracapsular technique … More
Removing the last nuclear piece
When we break the cataract nucleus into smaller fragments, we can sometimes have one of these small pieces stuck in … More
Understanding Force Directions in Phaco Chop
Many resident surgeons find it challenging to learn the technique of phaco chop because of the force vectors which are … More
Adjust the Phaco Probe Angle during Chop
The phaco probe angle changes during the procedure. When we embed the phaco tip into the nucleus, the probe is … More
Review: Beginning Surgeon Learns Phaco Chop
You’ve seen countless videos of phaco chop, but you seem to be stuck in a mode of less efficient techniques … More
Side View shows the Phaco Probe at a flat angle
While we do hold the phaco probe with a pencil grip, we do not use the same angle as writing … More
Foot Pedal Position during Phaco Chop
Learning phaco chop will make your cataract surgeries safer, more efficient, and more enjoyable to perform. And of course, phaco … More
Foot Pedal Positions for Learning Phaco Chop
Cataract surgery requires both hands and both feet of the surgeon in order to perform the modern techniques. It seems … More
Use the chopper to protect the capsular bag during phaco
The chopper can do so much more than just divide the nucleus into pieces. The chopper can fixate the eye, … More
Review: Solution for the Dense Nuclear Posterior Plate
Looking at this image should intimidate beginning cataract surgeons: this is a whitish-brown totally opaque cataract and it is a … More
The Chop failed because the nuclear halves did not separate
The phaco chop technique is like splitting firewood: the instrument creates the initial cleavage plane which then must be propagated … More
Review: Fully Separate Nucleus after the Phaco Chop
When doing phaco chop, remember that you must still physically push apart the nuclear halves to achieve complete separation and … More
Guest Surgeon: The UltraChopper for Dense Cataracts
Professor Luis Escaf from Barranquilla, Colombia presents a case here of a dense cataract with a small pupil. He uses … More
Review: Multiple Small Chops for a Dense Cataract
In previous videos, I have shown my technique for breaking up a dense brunescent cataract with a fibrous and tough … More
I just cannot chop this cataract – you’ll never guess why!
This seemed like a routine cataract surgery, but I was wrong. I just could not seem to chop this cataract … More
Review: Four Quadrant Chop-and-Conquer
The idea behind divide-and-conquer makes a lot of sense: divide the nucleus into four quadrants which are more easily phaco-aspirated … More
Review: Cracking the Posterior Plate in a Dense Cataract
With a dense brunescent cataract, one of the primary challenges is cracking the fibrous posterior plate of the nucleus. Using … More
Embed the phaco probe in the nucleus without ultrasound
The classic teaching for phaco chop and quadrant removal is to embed the phaco probe into the nuclear piece by … More
Chopper placement is critical to nucleus division
The placement of the chopper is critically important to achieving division of the cataract nucleus with the phaco chop technique. … More
If your Phaco Chop fails, simply revert to Stop-and-Chop
Sometimes we attempt to use phaco chop to divide the cataract nucleus, but we are just not able to achieve … More
The incision and capsulorhexis are your signature
I like to think of the phaco incision and the capsulorhexis as my “signature” on every cataract surgery that I … More
Probe Placement to Facilitate Phaco Chop
Placement of the phaco probe and the chopper are critical to facilitating the phaco chop procedure. One of the big … More
Flip and Chop Phaco is Ideal for Routine Cases
The flip and chop phaco technique has been presented here before on many occasions because it is such an efficient … More
Use the Chopper to Push Nuclear Pieces to the Probe
The chopper is used for many different functions during cataract surgery, beyond just chopping the nucleus into smaller fragments. Cataract … More
What beginner mistakes do you see in this pic?
Learning intra-ocular surgery is not easy and it can take years just to be comfortable with just the basics. Look … More
Resident Surgeon Struggles with Phaco Chop
In this anonymous video, a resident surgeon struggles with phaco chop. It is not an easy technique to learn, which … More
Beginning Surgeon Learns Phaco Chop – so can you!
You’ve seen countless videos of phaco chop, but you seem to be stuck in a mode of less efficient techniques … More
Expert Technique: Small Pupil & Dense Cataract
Very experienced surgeons never rest — they are always looking to learn more. Like you, I learn a lot from … More
After the chop, you must physically separate the nucleus
When doing phaco chop, remember that you must still physically push apart the nuclear halves to achieve complete separation and … More
Pre-Chop the Nucleus to Help a Novice Surgeon
Today we have a video of a novice surgeon operating together with an experienced surgeon. The key maneuver in this … More
How to Split the Cataract if the Chop is incomplete
Sometimes when we perform phaco chop, the lens does not fully divide. The chop scores and partially splits the nucleus, … More
Complete Toric IOL Case: from Marking to Alignment
Toric IOLs allow us to surgically treat corneal astigmatism at the time of cataract surgery thereby providing our patients with … More
Horizontal Phaco Chop for Efficient Cataract Surgery
The original phaco chop technique described by Dr. Nagahara in 1995 was the horizontal chop. This involves holding the lens … More
Hydro-delineate if the Capsulorhexis appears small
In this picture, the capsulorhexis appears to be on the small side, but it is actually just about perfect with … More
Use Multiple Small Chops for a Brunescent Cataract
In previous videos, I have shown my technique for breaking up a dense brunescent cataract with a fibrous and tough … More
Phaco Chop with Surgeon-Loaded Toric IOL
Yesterday’s video was a complete toric IOL case from marking to alignment, however the IOL was loaded by the technician … More
Learning from an External View of Phaco Chop
Most of the videos on this site are taken through the operating microscope. This gives the view of exactly what … More
Persistence during Phaco Chop is critical
It is critical that you not give up on phaco chop as a technique but also within a surgical procedure. … More
Vertical Chop Technique for Efficient Surgery
The vertical chop technique is a favorite of mine, particularly when there is sufficient nuclear density to allow the chop … More
Switching from Vertical Chop to Horizontal Chop
Sometimes cataract surgery is like playing basketball or soccer: you know many different techniques and special moves, but the key … More
Use the Chopper for Hemi-Nucleus Management
The chopper can do so much more than chop. It can be used to fixate the eye via the paracentesis, … More
Four Quadrant Chop & Conquer Technique
Many ophthalmologist in training start out by learning the four quadrant divide-and-conquer technique, which has a long history of being … More
Why did this Phaco Chop fail to split the cataract?
In order to do a successful phaco chop, we need to make sure that the high vacuum level of the … More
Why you MUST learn Phaco-Chop (Resident Case)
A critical part of being an accomplished ophthalmologist is keeping up with the advances in your field. For cataract surgery, … More
Cracking the Posterior Plate in a Dense Cataract
With a dense brunescent cataract, one of the primary challenges is cracking the fibrous posterior plate of the nucleus. Using … More
Floppy Iris Syndrome with Phaco Chop
We have a fun case here: the patient has a long-time history of Flomax (tamsulosin) use which limits his pupil … More
One-Chop Technique for Phaco Surgery
For a cataract with moderate nuclear density, splitting the nucleus into two halves can be sufficient for removal with phacoemulsification. … More
Management of the Hemi-Nucleus in Cataract Surgery
Whether you do phaco chop or stop-and-chop, you will be left with two halves of the nucleus which then need … More
Lifting the nucleus up though a small pupil
Here at CataractCoach, we have featured videos showing how to hydro-dissect a nucleus up, out of the capsular bag and … More
Adapting your Phaco Chop Technique to each Eye
I encourage ophthalmologists in training to learn multiple different nucleo-fractis techniques so that they can tailor the cataract surgery to … More
Solution for Incomplete Phaco Chops
You’re an experienced phaco chop surgeon and you come across a case where you just cannot get the chop to … More
Routine Dense White Cataract Surgery
Finishing up our week of routine cataract cases, today we are reviewing dense white cataracts. In some parts of the … More
Routine Phaco Chop Cataract Surgery
Continuing with our series about routine cataract cases, today we present a routine phaco chop surgery. The cataract is chopped … More
Routine Flip-and-Chop Cataract Surgery
We have previously featured an instructional video for the Flip-and-Chop method of cataract surgery and there was a very strong … More
Why I love Routine Cataract Cases
Many of the articles and videos here at CataractCoach.com feature unusual, difficult, or challenging cataract cases. These are fun videos … More
Cataract Surgery after Prior Vitrectomy
Cataract surgery in an eye which has undergone a prior pars plana vitrectomy is different in many ways, including lens … More
Pre-Chopper Technique for Phaco Surgery
The Pre-Chopper instrument was developed by Takayuki Akahoshi MD from Japan and it allows the cataract nucleus to be divided … More
Nucleus Chop with a 27g Cannula
It is the beginning of the academic year, which in the USA runs from July 1 (start) until June 30 … More
Flip and Chop early in the Learning Curve
Phaco Chop is my preferred technique of nucleus removal during cataract surgery because it is safe, efficient, and uses much … More
Phaco Chop with Floppy Iris Syndrome
Many of our male patients take medications to help with urinary flow such as alpha-1 antagonists, the most common of … More
Slow Motion Analysis of Phaco Chop
When we are watching a cataract surgery video to learn techniques from others, it is often difficult to understand the … More
Slow Motion Analysis of Phaco with EDOF IOL
Among our most popular features is the slow motion analysis of cataract surgery: when we slow down the video, we … More
Stop-and-Chop Technique for Cataract Surgery
The Stop-and-Chop technique for nucleus removal during cataract surgery blends aspects of the Divide-and-Conquer method with some Phaco Chop. Some … More
Why is phaco chop not working here?
This patient certainly needs cataract surgery because the dense nucleus has a large degree of central opacity and that has … More
Slow Motion Analysis of Cataract Surgery
There is a lot to be learned from slow-motion analysis and this applies to cataract surgery as well. Think of … More
White Cataract: What is USA Flag Sign? (Hint: Femto)
The USA Flag Sign is seen when we use a femtosecond laser to assist in phaco of a white cataract. (scroll … More
White Cataracts: They are not all the same!
You’ve seen the notation in the patient chart: “DWC” which stands for Dense White Cataract, but there is actually a … More
Cataract Surgery with Pupil Stretching
No need for pupil expansion rings or iris hooks for many cases (full video below) Yesterday’s video about dealing with … More
Pseudo-Exfoliation Cataract Surgery
Pseudo-Exfoliation / Small Pupil / Weak Zonules / Shallow AC (watch video below) A sweet 80 year old patient comes … More
Heterochromia Iridis Cataract Surgery
Heterochromia iridis is a condition where there are two different iris colors, usually one eye being darker than the other. … More
Posterior Polar Cataract: Expert Level with Small Pupil, Floppy Iris, Dense Lens
Yesterday’s video showed the technique of using Visco-Dissection to aid in surgery for posterior polar cataracts. That patient had a … More
Phaco Flip and Chop Technique
The phaco flip technique is when the nucleus is prolapsed out of the capsular bag and then emulsified at the … More
Combo Chop: Combining the Advantages of Horizontal and Vertical Phaco Chop
Phaco chop revisited: Combo-chop combines horizontal and vertical chop techniques Combining the advantages of the two techniques can simplify the … More
Cataract Surgery and Pterygium Avoidance
(scroll down to see the full narrated surgical video) In most patients who have both a pterygium and a cataract, … More
Cataract Surgery with Prior LASIK
With age, everyone who lives long enough will develop a cataract. This means that today’s LASIK patients will someday need … More
Cataract Surgery with a Mid-Size Pupil without using iris hooks or expansion devices
How do we do cataract surgery in an eye with a mid-sized pupil of about 3 or 4 mm in … More
Approach to the Dense Brunescent Cataract
With Increased Nuclear Density comes Increased Risks Here is how to successfully approach these tough cataract surgery cases: Patients with … More