Oblique Chop: A Novel Hook and Lock Technique for Single Step Nuclear Fracture in Cataract Surgery

To introduce and evaluate the efficacy of oblique chop technique designed to achieve single-pass nucleus division by leveraging both the tip and proximal arm of the chopper for simultaneous anchoring and splitting.

The oblique chop technique was performed in 60 eyes with cataracts ranging from nuclear sclerosis grades NS1 to NS3 (NS1: n=20, NS2: n=20, NS3: n=20). A side port incision was created between 90° and 100° relative to the main port to optimize the mechanical advantage for the hook-and-lock motion. During chopping, the tip of the chopper engages the central nucleus while the arm locks laterally, creating a hook-and-lock configuration that allows a single synchronized motion to fracture the nucleus without rotation or repeated attempts. The technique can be performed using a standard blunt chopper. Primary intraoperative parameters included single-attempt nuclear division rate, phacoemulsification time, cumulative dissipated energy (CDE), and capsular bag stability. Postoperative parameters included best-corrected visual acuity (BCVA), endothelial cell loss, and complication rates.

Complete nuclear division was achieved in 56 of 60 eyes (93.3%) overall-19/20 eyes (95%) in NS1, 19/20 eyes (95%) in NS2, and 18/20 eyes (90%) in NS3. Mean absolute phacoemulsification time was 15.0 ± 3.7 seconds, and mean CDE was 5.0 ± 1.4. Mean endothelial cell loss at 1 month was 3.5 ± 0.8%. Mean BCVA improved from 0.78 ± 0.20 logMAR preoperatively to 0.03 ± 0.05 logMAR postoperatively (p < 0.001). No significant intraoperative or postoperative complications were observed.

Oblique Chop is a simple, reproducible, and energy-efficient nucleus division technique that utilizes the full mechanical advantage of the chopper, enabling single-pass nucleus division with reduced ultrasound energy and favorable visual outcomes in nuclear sclerosis grades 1-3. Further comparative studies are warranted to validate these findings.