Mastering Phaco Chop Techniques Ashok Garg, Jorge L Alio, Robert J Weinstock, Frank Joseph Goes
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1Phacodynamics and Preliminary Considerations in Phaco Chop2

Phaco Chop in Transition: An Introduction1

Ashok Garg
(India)
Cataract Surgery has undergone tremendous revolution since the Evolution of Phaco technology which has made this procedure more safe, reliable and quicker. Modern Phaco systems equipped with new power modes, customized algorithms offer greater control of Intraocular conditions and increased efficiency are major factor of ophthalmology transitions from standard cataract surgery to new techniques of Refractive Lensectomy. Surgical outcomes previously acceptable to patients with impaired vision are now no longer considered sufficient. Improved instrumentation and high phaco technology allow the ophthalmologists to advance their techniques and develop their confidence to meet the challenges of success.
Although all steps of Modern Phaco from incision making to foldable lens implantation are quite important but Nucleus removal is most challenging and difficult part of entire procedure. Many alternative techniques have been devised. However Divide and conquer method introduced by Howard Gimbel has been widely adopted until Phaco Chop initially introduced by Dr. Nagahara has completely changed the nucleus removal scenario. In Phaco Chop nucleus is gripped with the phaco probe and second instrument is used to mechanically chop the nucleus into pieces. The amount of ultrasound energy delivered into the eye is reduced hence much of the lens fragmentation is performed Mechanically rather than by ultrasound energy. It has therefore become the technique of choice for all types of cataracts. The learning curve for Phaco Chop surgery is also minimum and it can be customized to accommodate any surgeon technique. Phaco chop has following advantages.
  1. Phaco Chop allows for an individualized approach to surgery and helps surgeons to avoid time consuming process of learning a new technique.
  2. Standard Phaco settings can be easily used to produce good results.
  3. Innovations incorporated in Phaco Chop are flexible and shall be able to support both current and future surgical techniques.
  4. Phaco Chop enables the surgeon to reduce endothelial trauma and the risk of capsular rupture as previously there was too much power used that could damage the iris and blood aqueous barrier as well as endothelium.
  5. Phaco chop with minimal power helps in more control, less surgical and reduced posterior capsular tear rate.
  6. Surgeon with Phaco Chop develop enough experience in short time to evaluate the performance of selected settings of Modern Phaco machines and make adjustments that reflect his/her technique.
  7. Phaco Chop is situation specific proactive approach which is effective in avoiding many complications.
  8. Phaco Chop is quite valuable in small pupil Phaco Surgery.
Since the introduction of Horizontal Phaco Chop technique by Dr K Nagahara, many leading ophthalmologists have subsequently added refinements. Now a days an array of various Phaco Chop techniques are available which are more faster, efficient and safer 4than previous standard technique. In this book a number of new Phaco Chop techniques have been described in details for the benefit of ophthalmic surgeons by leading International ophthalmologists. Various Phaco Chop techniques available are as follows:
  • Nagahara's Horizontal Chop
  • Pfeifer Quick Chop
  • Vertical Chop
  • Stop and Chop
  • Crater Phaco Chop
  • Scythe Chopper technique
  • Anteroposterior Phaco Chop
  • Bimanual Vertical Chop
  • Vejarano's Safe Chop
  • Burst Phaco Chop
  • Karate Chop
  • Locomotive Cored Phaco Chop
  • Bimanual Sleeveless Phaco Chop with 3D Visualization.
  • C-MICS Phaco Chop
  • Straight Phaco Chop
  • Quick Chop Express
  • BIMICS Phaco Chop
These are various Phaco Chop methods of nucleus disassembly. As the nucleus densties are variable in size and density and there is no one Phaco Chop Technique that fits all clinical conditions. With an array of advanced Phaco Chop techniques options available, the surgeon can select the technique depending upon soft, moderate or dense/very dense nucleus.
The combination of Modern vision Enhancement High Tech. Phaco Systems alongwith new Phaco Chop techniques the nucleus removal has become lot more easier, safer with overall efficiency and safety profile. Phaco Chop Techniques are invaluable addition to the ophthalmic surgeon armamentarium for better patient visual outcomes and satisfaction.
Bibliography
  1. Akahoshi T: The Kerate Prechop Technique, Cataract and Refractive Surgery Today, 2002: 2: 63–64.
  1. Alio J et al: Micro Incision Cataract Surgery Vs Coaxial Phacoemulsification, Ophthalmology 2005: 112: 1997–2003.
  1. David F. Chang: Phaco Chop Mastering Techniques: Slack 2005.
  1. Escaf L J et al: Ultra chopper: A new way to divide the nucleus, Cataract and Refractive Surgery Today, 2007: 3: 32–36.
  1. Izzet. Can et al: Comparison of Nagahara Phaco Chop and Stop and Chop Phacoemulsification nucleotomy techniques, Journal of Cataract and Refractive Surgery, 2004: 30, 663–68.
  1. Jorge. L Alio et al: MICS, Highlights of Ophthalmology, 2004 Edition.
  1. Kohnen T: Modern Cataract Surgery, 2002, 244 pages, Slack.
  1. Mark Packer, et. al: The Physics of Phaco: A Review, Journal of Cataract and Refractive Surgery, 2005; 31, 2, 424–31.