Having trouble learning phaco chop? Try this first...

One of the main reasons why phaco chop is more difficult to learn than divide-and-conquer is that there is a small window of time in which the chop needs to occur. With divide-and-conquer, once the groove is sculpted, the surgeon can take a long time to insert the instruments deep in the trench and achieve the nuclear split. With phaco chop, when the phaco tip is embedded into the nucleus and the high vacuum power is holding the nucleus, there is only about a 1 to 2 second window of time in which to accomplish the chop. After just a few seconds, the vacuum loses suction as the nucleus starts to crumble and then the chop is not likely to happen.

If we bring the nucleus out of the bag and then hold it between the chopper and the phaco tip, there is no rush. We can take our time because the nucleus is being held with opposing instruments and not just with vacuum. Doing the flip and chop technique makes this easier. The nucleus is brought out of the capsular bag using hydro-dissection and then the chopper is placed opposite the phaco probe on the other side of the nucleus. The instruments are then brought together and then apart to achieve the split.

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