Eyeworld

EW CATARACT 45 September 2018 'soft slice' technique is a different approach and is effective for up to 2+ nuclei." Here, the nucleus is sliced from the periphery to the center using a device like the Mackool iris reposi- tor, which is blunt and has a short shaft. After each slice is completed, the segments can be separated until the nucleus is in four pieces, at which point it can be removed with minimal use of ultrasound power. Soft slice Surgeons should be comfortable mixing chopping approaches as the situation demands in this picture, a soft chop Hard chop Crack ergonomics: The long axis of the trench should bisect the surgeon's instruments, cracking the nucleus from the bottom Source (all): Richard Packard, MD continued on page 46 Phaco chop allows for fast and safe surgery, especially for hard cataracts, that need far lower energy levels in the eye due to the greater use of mechanical division, produc- ing clearer day 1 corneas because of the lower energy use. There are two basic techniques, horizontal and vertical chopping, which can be mixed and matched. "Horizontal choppers tend to be longer with a blunt end and often with a blade on the inside edge. Vertical choppers have shorter tips, often with a point. I use my own, which has a blade on the inside also. These differences reflect the way in which the two techniques are used," Dr. Packard explained. "Horizontal chopping is very much a two-dimensional maneuver. You embed the phaco tip, then take the chopper out to the periphery of the nucleus and slide it over the nucleus, bringing the two instru- ments together and separating into segments. You can chop up the nucleus as many times as you like, but this is especially important with a hard cataract, which will enable you to use less power. Vertical chopping is a three-dimensional maneuver because you are lifting at the same time as you are chopping

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