EW CATARACT
36
by Steve Elieff, MD
An in-depth look at anterior
chop/nuclear elevation
A
nterior chop/nuclear
elevation (AC/NE) is an
alternative method of
nuclear disassembly in
which the lens nucleus,
following initial hemisection, is frag-
mented and lifted from the capsular
bag without the use of ultrasound
or vacuum. In AC/NE, the chopping
instrument is placed underneath the
opposing heminucleus and drawn
upward (anteriorly) toward a station-
ary phaco tip resting on the ante-
rior lens surface. The resultant lens
fragment is then elevated manually
with the chopper to the supracap-
sular space for phacoemulsification.
Working at a safe distance from the
peripheral lens and posterior cap-
sule, and without ultrasound or vac-
uum for fragmentation and eleva-
tion of the heminucleus, the phaco
Alternative method of nuclear disassembly
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Tips and tricks
Figure 1. The chopper is placed deep in the capsular bag, blunt side down, adjacent to the
opposite heminucleus for removal of the first fragment. Note the femto laser pre-chop
cleavage planes.
tip poses a significantly reduced risk
of capsular rupture.
Traditional nuclear disassem-
bly by lens sculpting (divide and
conquer), which remains a safe and
commonly employed technique, has
given way to horizontal and vertical
chopping methods due to improved
efficiency, decreased phaco times,
and reduced risk of capsular rupture
or iris damage. All of these tech-
niques, however, involve position-
ing the phaco tip at varying depths
in the posterior chamber, either for
nuclear removal or stabilization.
Following an initial hemisection of
the lens nucleus, AC/NE affords a
safe, easy-to-perform alternative in
which the phaco tip remains near
the iris plane.
Technique
The potential space posterior to the
lens nucleus has been avoided by
cataract surgeons due to possible
October 2017
