Rotary Chop: A New Technique for Teaching Chop and Tackling Mature Cataracts

Here we describe a new cataract chop technique that is most valuable for two groups of ophthalmologists: (1) experienced surgeons encountering challenging nuclear fragmentation due to mature cataracts or zonulopathies, and (2) inexperienced surgeons wishing to develop skills necessary for chopping techniques.

We have termed this new method "rotary chop," since the partial thickness pilot holes created by the phacoemulsification (phaco) tip around the periphery of the nucleus produce a rotary phone dial appearance on the surface of the cataract. By creating these pilot holes, the surgeon is able to easily place the chopper deep into the body of the nucleus, avoiding the need to apply vertical piercing force to the nucleus.

The patient in the technical video had a 4+ nuclear sclerosis cataract. The preoperative vision in this eye was counting fingers at 2 feet with no improvement with refraction. On postoperative day 1, visual acuity had improved to 20/80 . By postoperative week 1, best-corrected visual acuity was 20/20 (20/25-2 uncorrected).

This method avoids unnecessary zonular stress. Additionally, inexperienced surgeons using this technique during routine cataract surgery are able to quickly master the movements necessary for both vertical and horizontal chop in a safer environment.