TERMINAL CHOP (6) :: HARD CATARACT : GRADE VI NUCLEUS : SMALL PUPIL: Rajendra Prasad скачать в хорошем качестве

TERMINAL CHOP (6) :: HARD CATARACT : GRADE VI NUCLEUS : SMALL PUPIL: Rajendra Prasad

Terminal Chop technique enables us to obtain a complete full thickness nuclear segmentation including the posterior plate in first attempt, with least manipulation, minimal use of phaco energy, minimal stress on zonules and posterior capsule, very quick within 5 seconds, with tremendous ease , quite simple, easy to learn , even in grade 5-6 nucleus of hard cataract. IN TERMINAL CHOP First step:- 1: We create a short shallow narrow central trench (1mmX 1mmx1mm) which is sufficient to fit the phaco tip to achieve a proper plane of depth in the nucleus. Second step 2: Direction and depth of the phaco probe :-phaco probe is impaled from the distal end of the trench superficially directed towards equator parallel to pupillary plane to hold the nucleus with in the equator. It's very simple and safe. ( we don't have to impale deep at the centre of the nucleus like in horizontal chop which could many a times endanger the posterior capsule and it's really difficult to assess the depth of probe) Third step 3: position of chopper A olive tipped blunt chopper is hooked full thickness around the equator under direct visualisation and remains at the equator instead of moving towards centre of the nucleus. We actually don't chop the nucleus Chopper is blunt just used to hold and stabilise the equator if the nucleus adjacent to the phaco probe and helps to initiate a unique 90 degree lateral vector force to split the nucleus beginning at the equator towards centre and to the equator on the other side. ( while in horizontal chop phaco probe is deep at the centre of nucleus and chopper initiate incising the nucleus from periphery which is quite difficult in hard cataract::excessive force applied to bring the chopper towards phaco probe at the centre of the nucleus leads to rotation or circular movement of nucleus around the axis of phaco probe which in turn cause misdirected vector forces resulting into incomplete or uneven nucleus division.) Fourth step 4: Both the instruments positioned at the equator make a lateral movement initiating full thickness nuclear division at the equator with the help of simple laterally directed vector forces splitting the entire nucleus including posterior plate from the equator to equator. In terminal chop full thickness nuclear split begins at the equator progresses towards centre and then towards the equator on the other side. ( while in horizontal chop nuclear split or lateral movement of the instruments begin at the bulky and hard central nucleus which is extremely difficult and often incomplete.)