Sequential Zero-Vacuum Horizontal Chop For Cataract Surgery

To describe a sequential zero-vacuum horizontal chopping technique designed to facilitate extensive mechanical nuclear fragmentation while minimizing reliance on ultrasound energy and high vacuum levels during phacoemulsification.

A single-surgeon surgical series performed at a tertiary eye care center.

After continuous curvilinear capsulorhexis and hydrodissection, a central trench measuring approximately 1.0–1.5 mm in length, one phaco tip width, and 1.0–1.5 phaco tip depth was created from the surgeon side toward the nuclear center. Minimal phaco power was applied within the trench to build limited vacuum and stabilize the nucleus.
A ball-tip chopper was advanced beneath the anterior capsule toward the equator. Once the chopper reached the equatorial position, the foot pedal was returned to irrigation-only mode (step 1), and horizontal chopping was performed. This maneuver was repeated until the nucleus was divided into at least eight small fragments. Ultrasound energy was applied only during fragment removal.

Sequential mechanical chopping enabled effective nuclear segmentation into multiple small fragments prior to phacoemulsification. The technique was applied in 12 consecutive cases of dense cataracts graded LOCS III 4–6, achieving stable anterior chamber dynamics with limited ultrasound usage. No posterior capsule rupture or major intraoperative complications were observed.

Sequential zero-vacuum horizontal chopping allows controlled mechanical nuclear fragmentation while reducing ultrasound energy requirements and limiting excessive vacuum build-up. By favoring nuclear fragmentation and phacoemulsification closer to the anterior capsular plane or within the capsular bag whenever feasible, the technique facilitates manipulation away from the corneal endothelium and promotes stable anterior chamber dynamics. The use of a ball-tip chopper allows safer equatorial access and reduces the risk of surge-related or instrument-related capsular injury. Although demonstrated in dense cataracts, this approach may be applicable across a wide range of nuclear densities.