Half stop and chop, petal by petal deflowering of hard cataracts

Dear Editor,

I read with interest the article by Upadhyay et al. titled “Comparative evaluation of modified crater (endonucleation) chop and conventional crater chop techniques during phacoemusification of hard nuclear cataracts: A randomized study.”[1]

We describe a surgical maneuver of dismantling hard brown nuclei using the half stop and chop, petal by petal deflowering of the cataract.

The steps of the phacoemulsification procedure are as follows:

1. Phacoemusification begins with the phaco tip positioned in the central area of the lens, and a trench is made [Video clip 1] using 80% power and 40 mmHg suction on a venturi machine, so that it penetrates two thirds the depth.

2. Then, the nucleus is rotated 180° and a chop is performed getting a good hold on the half-sculpted ledge [Video clip 2] with the settings of 80% power in the pulsed mode and 300 mmHg vacuum.

3. Two hemi-nuclei are formed which have posterior lens fibers joined due to the hardness of the nucleus, where the posterior lens fibers and hard epinuclear fibers are intertwined.

4. The trench gives an open area for multiple small half chops of each hemi-nucleus into five to six small sectors, leaving the posterior plate intact, which resembles the corolla of a flower.

5. Then, with vacuum of 350 mmHg in pulsed phaco mode, each of the petals is plucked [Video clip 3] from the posterior plate till all the chopped segments are eaten up.

6. The residual posterior plate is flipped over and easily emulsified.

7. The advantage of this procedure is that the full surgery is performed in the posterior chamber, and consequently endothelial trauma is prevented.

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Nil.

Conflicts of interest

There are no conflicts of interest.