Terminal Chop: A New Surgical Technique For Hard Mature Cataract

To evaluate a new efficient simple swift and safe cracking and breaking technique of solid hard mature cataract with terminator the wedge tool enabling a full thickness nuclear segmentation with least fracture force, least manipulation and stress, much lower than compressive stress, causing minimal trauma and highly satisfactory results.

A one year, non-randomized prospective series of 1008 eyes of 679 subjects who underwent elective phacoemulsification for cataract of nuclear opalescence of grade II or more (LOCS III) at R P Eye institute Vasant Kunj New Delhi.

The technique is consonant to drag picks in rock excavation system, in which a specially designed tool terminator is used to initiate a full thickness nuclear crack at the equator which automatically traverses through the centre of the nucleus, over to the equator on the other side, breaking the entire nucleus into two complete pieces thus requiring least fracture force, least manipulation and stress, much lower than compressive stress. Full thickness free segments are then drawn and emulsified with phaco tip.

The terminal chop technique was successfully performed in all 1000 eyes of 679 patients who underwent elective phacoemulsification and IOL implantation, during a period of 1 year at the 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 II, III, IV, V and VI were included. The terminal chop technique was successful in achieving a full thickness nuclear segmentation in all 1000 eyes operated. Preoperative VA log mar 1.56 improved to VA log mar 0.16 that is 89.75%. Corneal endothelial cell count reduction was only 4.36% much less than any technique reported.

Terminal Chop technique is an efficient, safe, simple and swift procedure for full thickness nuclear segmentation, giving consistent results, especially in hard mature cataracts. Principle of mechanical rock excavation with drag pick wedge tool system could be safely used to crack and break these solid mature hard cataracts with minimal stress.