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Terminal chop: a new surgical approach for hard mature cataract

Poster Details

First Author: R.Prasad INDIA

Co Author(s):    A. Badhani   G. Badhani           

Abstract Details

Purpose:

Several techniques have been defined and compared for chopping nucleus in hard mature cataract, but still many surgeons report difficulty with full thickness division of hard leathery nucleus. We aim to describe a new technique to chop hard mature nucleus, which has enabled a successful full thickness nuclear division through the posterior plate in 100 per cent of the attempted cases, with ease and safety. This technique combines the advantages of ‘phaco chop’ and ‘stop and chop’ techniques to unfold a whole new dimension in mechanics of nuclear segmentation.

Setting:

This technique was innovated while performing routine cataract surgeries at RP Eye Institute, Holy Angels Hospital, Vasant Vihar, New Delhi, India.

Methods:

108 eyes of 79 patients underwent elective phacoemulsification. The cataract was graded according to LOCS III and eyes with NO of grade IV and more were included. The phaco tip was engaged at the distal end of a short shallow central trench, and impaled into the nucleus to grip the midperiphery. A blunt tipped chopper was hooked then drawn just 2 mm into the terminal edge of equator. The lateral separation of two instruments is initiated just outside the capsular bag giving minimal stress on the zonules, splitting the nucleus from equator to equator through centre.

Results:

108 eyes of 79 patients (33 males, 46 females), underwent elective phacoemulsification and IOL implantation, during a period of 1 year at our centre. The average age was 68.3 ± 6 years. The cataract was graded according to the Lens Opacities Classification System III (LOCS III) and eyes with nuclear opalescence (NO) grade IV, V and VI were included. The terminal chop technique was successful in achieving a full thickness nuclear segmentation in all 108 eyes operated. No intraoperative or postoperative complications were noted.

Conclusions:

The Terminal chop technique ensures a complete nuclear segmentation including the posterior plate in first attempt. This technique differs from other chopping methods because we chop only the terminal end of nucleus in the direction of the trench with minimal horizontal excursion of the chopper, initiating the full thickness division of the lens fibres from the equator. The chop is initiated in the prolapsed terminal edge of the nucleus just outside the capsular bag, thus giving minimal stress on the zonules. This technique is an efficient and safe method for nuclear segmentation, giving consistent results, especially in hard mature cataracts. FINANCIAL DISCLOUSRE: NONE

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