Dr. Rajendra Prasad,
P14714
Purpose (max 100 words):
Several techniques have been defined and compared for chopping nucleus in hard mature cataract, but still many surgeons report difficulty with full thickness division of hard leathery nucleus. We aim to describe a new technique to chop hard mature nucleus, which has enabled a successful full thickness nuclear division through the posterior plate in 100 per cent of the attempted cases, with ease and safety. This technique unfolds a whole new dimension in mechanics of nuclear segmentation.
Setting/Venue (max 50 words):
The concept of terminal chop technique evolved with extensive clinical experiments performed on the extracted hard nucleus procured from the extra capsular cataract surgery in our clinical set up.
Methods (max 100 words):
A one year, non-randomised prospective series of 108 eyes of 79 patients (33 males, 46 females) underwent elective Terminal chop phacoemulsification and IOL implantation. The average age was 68.3 ± 6 years. The cataract was graded according to the Lens Opacities Classification System III (LOCS III) and eyes with nuclear opalescence (NO) grade IV, V and VI was included.
The mechanics utilized in this technique involves creation of a short central shallow trench of phaco tip diameter deep and breadth to engage and impale the nucleus directed towards the equator parallel to the pupillary plane to achieve a firm grip at the periphery of the nucleus.
A blunt tipped chopper is then engaged around the thin and softer peripheral nucleus and while drawing the chopper into the nucleus create a small full thickness nick adjacent to the phaco tip while simultaneously achieving firm hold of the nucleus without any horizontal excursion of the chopper. Once both the instruments have achieved firm grip of the nucleus at the equator, chopper and phaco tip are then separated 90° laterally to initiate the nuclear tear from the initial nick given at the equatorial edge of the nucleus The force vector of 90 degrees lateral separation is then continued until splitting the entire nucleus from the equator to equator through the centre into two complete clean halves.
Results (max 100 words): The terminal chop technique was successful in achieving a full thickness nuclear segmentation in all 108 eyes operated. No intraoperative or postoperative complications were noted.
Conclusions (max 100 words):
Terminal chop is very simple, safe and effective surgical technique utilizing the advantages of unique mechanical forces segmenting the entire nucleus into two clean halves with minimum use of ultrasound energy, and least manipulation with in the capsular bag. Mechanical forces utilised in terminal chop is unfolding a whole new dimension in mechanics of nuclear segmentation. without penetrating deep into the centre of the nucleus, terminal chop technique ensures a complete nuclear segmentation including the posterior plate in first attempt. The mechanics utilised in this technique is highly efficient and safe unfolding a whole new dimension in the history of phaco cataract surgery. Terminal chop has several advantages over the other techniques currently used to ensure less endothelial cell loss and less postoperative inflammation leading to a faster recovery and maximal visual rehabilitation. Complete nuclear segmentation achieved with terminal chop propagates quick and safe nuclear fragment emulsification with least manipulation and minimal use of phaco energy resulting into highly satisfactory postoperative results.