Terminal chop for full thickness nuclear segmentation in mature hard cataract


Posted: Tuesday, April 25, 2017

Rajendara Prasad
Rajendra Prasad, MBBS, MD (Ophthalmology) Director and Consultant,
RP Eye Institute, Vasant Kunj, New Delhi

‘Direct chop’ has become the procedure of choice in hard cataracts, but is still fraught with incomplete cracks and difficult instrument manipulation.There is now a new technique, ‘Terminal Chop’, for full thickness nuclear segmentation in hard cataract.
A short, shallow, central trench is sculpted in the central nucleus, the phaco tip is engaged at the distal end of the trench and impaled into the nucleus, keeping the tip directed towards the equator parallel to the pupillary plane within the superficial layers of the nucleus. The equator of the nucleus is then slightly drawn within the capsulotomy edge.
A specially designed blunt-tipped chopper called Terminator is then simply passed around the lens equator and hooked. The chopper is then drawn within the equator of the nucleus to create a small groove, but while creating the groove, the chopper also generate tension at the sides of the groove and initiates a full-thickness crack.

The initial crack then simply traverses through the centre and to the equator on the other side, breaking the entire nucleus into two complete pieces with lateral separation vector force created by lateral separation of both the instruments.

In the unique mechanics of terminal chop, to crack and break these hard nuclei similar to drag tools in rock excavation system, the chopper plays an important role as the critical instrument manoeuvre to crack the nucleus is performed by the chopper along with the phaco probe.
The chopper used in Terminal Chop a well-acclaimed recently introduced new surgical technique by Rajendra Prasad is named as Terminator. Terminator is a specially designed blunt olive tip chopper to safely hook, hold, stabilize and then initiate a crack at the equator of the nucleus to completely break the nucleus into two complete halves.

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