This video shows how to learn horizontal chop in a step-by-step fashion. Chopping is a great technique to efficiently disassemble any nucleus. It remains an underutilized technique and I think this is because it can be difficult to learn. Here I show how to learn it by following a few easy steps. Step one is to remove the anterior epinucleus in the area of the capsulorhexis and then, near the main incision, make a tunnel or "pot-hole" on sculpt mode deep enough to get to the sleeve of the phaco tip (I learned this from David Lubeck, MD). Next, place the chopper out over the nucleus. To ensure you're under the anterior capsule, you can touch the chopper tip to the nucleus as you push it out to guarantee it stays under the capsule. I like a 90-degree Nagahara style chopper (the Dodick chopper from Katena is shown) since you can really hook and stabilize the lens in contradistinction to the Seibel chopper which is curved (when mine was accidently bent to 90 degrees I actually found it to be more reliable). Next add vacuum if you need (typically only necessary on a grade 3+ or higher). I have a special chop setting on the phaco machine which uses traditional phaco in burst mode and increasing amounts of vacuum (grade 2: 350mm Hg; grade 3: 400mm Hg; grade 4: 450mm Hg). Then, without moving the phaco tip at all, bring the chopper toward the phaco tip and separate the pieces. It is really critical to make sure you can see the red reflex when separating the pieces to ensure complete full separation. After the lens is separated into two pieces, without moving the phaco tip at all, you can re-pass the chopper 30 to 90 degrees away from the initial chop to make the first piece. The first piece can then be pulled out of the capsular bag and emulsified and then this process is repeated. I believe it is safer to switch the chopper out for a spatula type instrument when there is only one piece of the nucleus left to protect the posterior capsule. Any comments or suggestions are appreciated.
