Chopping Strategies: Horizontal, Vertical, Prechop, and Beyond

莊智鈞 Chih-Chun ChuangTaiwan Speaker Chopping Strategies: Horizontal, Vertical, Prechop, and BeyondThe "Phaco Chop" techniques—Horizontal, Vertical, and Prechop—are advanced surgical strategies used in phacoemulsification to fragment the eye's cloudy lens nucleus. The goal of all chop techniques is to reduce the amount of ultrasound energy and time needed for removal, which minimizes damage to the corneal endothelium and other ocular structures. Phaco Chop leads to significant surgical benefits including (1) Minimized Zonular Stress: By stabilizing the nucleus with the phaco tip and applying opposing forces centripetally, the stress transmitted to the delicate zonules is drastically reduced compared to the grooving required in the "Divide and Conquer" technique. (2) Reduced Phaco Power & Time: Replacing the need to sculpt trenches with mechanical cleavage saves ultrasound energy and shortens the overall procedure time. (3) Safety in Challenging Cases: Small Pupils: The technique keeps all major movements contained within the central 3–4 mm of the pupil, avoiding the need to work under a small iris. (4) Dense Cataracts: Vertical chop, in particular, can efficiently split hard, brunescent nuclei that would otherwise require excessive, damaging ultrasound energy. In short, Phaco Chop is an elegant solution in cataract surgery that leverages the physical properties of the lens (cleavage planes) to substitute energy-intensive destruction with controlled, mechanical fragmentation, resulting in a safer, faster, and less traumatic operation for the eye. Beyond the basic Horizontal and Vertical Phaco Chop techniques, various advanced and hybrid strategies have also evolved in cataract surgery to improve safety, efficiency, and adaptability for different cataract types and eye conditions.