Tilt-and-crush: A safe, effective and energy-saving technique for soft cataract removal

The tilt and crush technique is a modified chopping technique developed mainly to maximize safety and effectiveness in emulsifying soft cataracts.

After clear corneal incision and continuous curvilinear capsulorhexis, the hydro-dissection cannula is introduced under the anterior capsule about 90 degrees to the axis of the main wound and injection of fluid is continued until the distal pole of the nucleus prolapses out of the capsulorhexis rim into the anterior chamber. The centre of the nucleus is then engaged with the phacoemulsification tip using high vacuum and tilted vertically in the anterior chamber. The second instrument is passed behind the full length of the vertically tilted nucleus to crush it against the phacoemulsification tip.

This technique was successfully performed in 517 eyes by a single experienced surgeon. The mean effective phaco time was 0.11 ± 0.32 s, and it was zero in 382 (73.9%) eyes. The mean total phaco time was 4.79 ± 10.71 s. In 322 (62.3%) eyes, no phaco energy was utilized to remove cataract. None of the eyes experienced any complication during or after the surgery.

This safe and reliable technique is significantly more energy-efficient compared to other traditional techniques like divide-and-conquer and phaco-chop. Unlike, some widely known pre-chopping techniques, it can be taught easily with good reproducibility.