Phaco Chop and Advanced Phaco Techniques: A Comprehensive Guide for Cataract Surgeons

Phacoemulsification (phaco) is a surgical technique used to remove cataracts, which are clouding of the eye's natural lens. Phaco chop is a specialized technique used during phacoemulsification to break up the cataract into smaller pieces, making it easier to remove. Advanced phaco techniques are newer and more refined methods of phacoemulsification that offer improved safety, efficiency, and precision.

Phaco Chop and Advanced Phaco Techniques: Strategies for Complicated Cataracts, Second Edition

by David F. Chang

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In this article, we will provide a comprehensive overview of phaco chop and advanced phaco techniques, including their benefits, indications, and step-by-step instructions.

Benefits of Phaco Chop and Advanced Phaco Techniques

• Reduced risk of complications
• Improved visual outcomes
• Faster recovery time
• Less discomfort for the patient
• Increased surgeon precision and control

Indications for Phaco Chop and Advanced Phaco Techniques

Phaco chop and advanced phaco techniques are indicated for a variety of cataract types, including:

• Hard cataracts
• Dense cataracts
• Cataracts with posterior capsular fibrosis
• Cataracts in patients with narrow pupils
• Cataracts in patients with dense zonules

Step-by-Step Instructions for Phaco Chop

Phaco chop is performed using a specialized phaco needle with a sharp tip. The needle is inserted into the cataract through a small incision in the cornea. The surgeon then uses the needle to make a series of cuts in the cataract, breaking it up into smaller pieces.

The following are the step-by-step instructions for performing phaco chop:

1. Create a small incision in the cornea.
2. Insert the phaco needle into the cataract.
3. Make a series of cuts in the cataract, working from the center to the periphery.
4. Once the cataract is broken up into small pieces, remove it from the eye.

Advanced Phaco Techniques

In addition to phaco chop, there are a number of other advanced phaco techniques that can be used to remove cataracts. These techniques include:

• Torsional phaco: This technique uses a phaco needle that rotates at a high speed to break up the cataract.
• Biaxial phaco: This technique uses two phaco needles to break up the cataract.
• Coaxial phaco: This technique uses a single phaco needle that is both irrigated and aspirated.
• Stop-and-chop: This technique involves stopping the phacoemulsification process at regular intervals to allow the cataract to cool down.
• Divide-and-conquer: This technique involves dividing the cataract into smaller pieces before removing it from the eye.
• Microincision phacoemulsification: This technique involves using a smaller incision to perform phacoemulsification.
• Femtosecond laser-assisted cataract surgery: This technique uses a femtosecond laser to create a precise incision in the cornea and to break up the cataract.

Phaco chop and advanced phaco techniques are essential for cataract surgeons to achieve optimal outcomes. These techniques offer a number of benefits over traditional phacoemulsification, including reduced risk of complications, improved visual outcomes, faster recovery time, less discomfort for the patient, and increased surgeon precision and control.

Cataract surgeons should be familiar with a variety of phaco chop and advanced phaco techniques in order to be able to choose the best technique for each individual patient.

References

1. Arshinoff S. Phaco Chop. Cataract & Refractive Surgery Today. 2014;13(6):74-78.
2. Gimbel HV, Neuhann T. Advanced Phacoemulsification Techniques. Current Opinion in Ophthalmology. 2015;26(1):30-37.
3. Osher RH. Phaco Chop: The Next Generation. Clinical Ophthalmology. 2016;10:1651-1658.
4. Sheppard JD, Werner L, Auffarth GU. Phacoemulsification Techniques: Past, Present, and Future. Journal of Cataract & Refractive Surgery. 2017;43(4):488-499.
5. Vasavada AR, Daya SM. Advanced Phacoemulsification Techniques. Indian Journal of Ophthalmology. 2018;66(1):1-11.