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B. Amspaugh, C. Springs, C. Yung; Technique to Ease the Transition From Cracking to Chopping in Phacoemulsification. Invest. Ophthalmol. Vis. Sci. 2007;48(13):1047.
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In cataract surgery via phacoemulsification, it is advantageous to become skilled in both cracking and chopping techniques in order to remove nuclear lens material effectively. Cracking techniques are generally taught first to trainee surgeons; they are easier to master with less risk of complications. Chopping techniques, once mastered, cause less stress on the capsular bag, utilize less ultrasound power, and are faster.Chopping, however, can be difficult to master. One difficulty for beginners involves embedding the phaco tip within the nucleus in order to hold the nucleus stationary during chopping. While holding the nucleus stationary under high vacuum with the phaco tip, a second instrument must be introduced and manipulated in the anterior chamber to disassemble the nucleus.We describe a technique that introduces the trainee surgeon to this dynamic process with the benefits of both the cracking and the chopping methods.
After obtaining proficiency in the divide-and-conquer cracking technique, trainee surgeons at Indiana University performed cataract extraction via phacoemulsification and the cases were videotaped (n=10). After adequate hydrodissection and hydrodelineation, a deep central groove is sculpted in the nucleus. The nucleus is then rotated 90 degrees, and another linear groove is created perpendicular to the original groove, as in the traditional cracking/divide-and-conquer technique. The phaco tip is then buried within a quadrant under high vacuum, low phaco power settings, effectively holding the quadrant in position. A second instrument is inserted at the base of the previously created groove and the phaco tip and second instrument are gently separated to effectively create two quadrants. This technique is repeated until four nuclear quadrants are created.
This technique resulted in an easier transition to chopping as measured by review of the operative videotapes by supervising cataract surgeons at Indiana University.
This technique allows for smoother transition to chopping for trainee surgeons. By introducing chopping techniques in a stepwise fashion, so that only one variable is changed in the beginning surgeon's technique, a smoother transition is obtained. That is, mastering the technique of holding the nuclear material under high vacuum conditions with the phaco tip is critical to the chopping technique. Once the nuclear material is held in place, a second instrument is introduced to disassemble the nucleus by the familiar cracking technique.
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