How to Vertical Chop Brunescent Cataracts- Chris Teng, MD скачать в хорошем качестве

How to Vertical Chop Brunescent Cataracts- Chris Teng, MD

Many residents and attendings have asked me about Vertical Chopping. In my opinion, this is the optimal technique to remove 2-4+ cataracts. For very dense cataracts, of the 4+ density, one option is extracapsular technique. Another option is divide and conquer. Another option is to vertical chop. This is a video demonstrating how to remove dense brunescent cataracts using vertical chop technique. I left the cataract removal in real time, with no editing, other than the instructional captions. A few points: 1. The most important instrument in vertical chop is the phaco handpiece. Meaning, the phaco tip vacuum hold on the nucleus needs to be strong. Once this is accomplished, the sharp vertical chopper is used in a down and out motion. Contrast this to horizontal chop, where the most important instrument is the horizontal chopper, which chops the nucleus in the horizontal plane. 2. The wound positions need to be well placed. To maximize angles and approach, the paracentesis and main wound should be 30-45 degrees apart. 3. For very dense cataracts, after the vertical chops, the nucleus will still be connected at the fleurette posteriorly. In these cases, after vertical chopping, debulk the nucleus by sculpting more posteriorly, then remove the chopped pieces. When removing the chopped pieces, if they are still connected posteriorly, use a horizontal back chop to chop the piece from its posterior connection.