Inverse chop/Prop technique for phacoemulsification of soft cataracts and posterior polar cataracts

Soft cataracts pose significant challenges during phacoemulsification due to the pliable nature of the nucleus, which often leads to difficulty in cracking, cheese-wiring of instruments, and frequent occlusion breaks. Several fragmentation and non-fragmentation techniques have been described to manage such cases safely. We describe an inverse chop/prop technique that utilizes a blunt Sinskey hook to mobilize and crack the nucleus, facilitating safe and controlled phacoemulsification. This approach is also applicable for in situ phacoemulsification in posterior polar cataracts (PPCs), eliminating the need for nucleus rotation. We used this technique in patients with lens opacities classification system (LOCS) III grade 1-2 soft cataracts and PPCs. The technique involves introducing the Sinskey hook beneath an uncracked, partially cracked, or cracked nucleus to further crack or prop it, enabling subsequent emulsification. In PPCs, the hook is inserted via either side port to mobilize and crack the nucleus without rotation, permitting direct in situ emulsification. Cortex aspiration and intraocular lens (IOL) implantation are completed as per standard protocol. The technique was successfully performed in 188 patients without any procedure-related complications, including four cases with PPCs. In 50 cases, it proved particularly advantageous when conventional techniques encountered difficulty during emulsification. The inverse chop technique represents a valuable addition to the armamentarium for phacoemulsification of soft cataracts and PPCs, enhancing safety, control, and intraoperative efficiency.