This is a compilation of some of the cases I did just last week.

In my opinion, phaco chop is the most safe and efficient way to disassemble and emulsify the lens. Sculpting requires more ultrasound energy, flipping techniques risk potential damage to the corneal endothelium, prechopping requires additional instrumentation, and the femtosecond laser requires an expensive laser.

But even horizontal and vertical chop traditionally require ultrasound and high vacuum to bury the phaco tip and hold the endonucleus to do the chop maneuver. This is not only potentially dangerous to the posterior capsule but also unnecessary. My technique is a new variation called Double Chop. The Double Chop maneuver is performed by passing the chopper out to the equator and then placing the phaco tip subincisionally around the equator to act as a second chopper. This is possible because most all endonuclei (except the hyperbrunescent) have a diameter smaller than the capsulorhexis opening in order to place the chopper and the phaco tip down and around the equator. Both instruments are brought centrally and the chop is initiated. The subsequent chop maneuver is called Cross Chop in which the chopper is placed across the paracentesis 180 degrees and "crosses" over the phaco tip to get under the anterior capsule and around the equator to chop one of the heminuclei. I published this technique in 2009, JCRS. All subsequent chops are carried out by the chopper and the phaco tip is always held in the central safe zone to act as leverage to fracture the pieces and then emulsified. Ultrasound and vacuum are never used during any chop, maneuver, as a result this is safer. Ultrasound and vacuum are only initiated during emulsification and removal while in the central safe zone. The chopper is safe and versatile for all intracapsular manipulation. The chopper is used to grab endonuclear fragments, spin the lens, and epinuclear pieces in hard to reach places. The phaco handpiece is relegated to a passive player only to act as leverage for chop and to emulsify the lens material. Most all the action is led by the chopper. I believe my technique is extremely safe, efficient, and straight-forward. And I hope this was helpful to you.

D. Brian Kim, MD
Professional Eye Associates
1111 Professional Blvd
Dalton, GA 30720
www.professionaleye.com
706-226-2020

свернуть