Middle prechop: Fracturing the middle portion of the nucleus

To decrease the use of ultrasound power, prechop techniques such as preslice and Akahoshi prechop have been developed. We describe a technique that fractures the nucleus through the center of the lens before chopping. After a continuous curvilinear capsulorhexis is created, an ophthalmic viscosurgical device is injected into the anterior chamber and 2 modified cystotomes are inserted into the lens with a back-and-forth movement; a small amount of pressure from opposite sides is applied to fracture the nucleus. Hydrodissection is then performed, followed by phacoemulsification.