Stop and Chop Technique

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Article initiated by:

Susan MacDonald MD

All contributors:

Alpa S. Patel, M.D., Douglas M. Wisner, MD, Derek W DelMonte, MD, Susan MacDonald MD, Angela Verkade, MD

Assigned editor:

Angela Verkade, MD

Review:

Assigned status Up to Date

 by Angela Verkade, MD on May 30, 2024.

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Contributing Editors:	add

Divide and conquer technique shifting into a chopping technique with the Stop and Chop

Chopping

• Using phaco needle, shave nuclear material to make a trough,
  • With divide and conquer you usually make 4 quadrants, with Stop and Chop technique the nucleus is divided in half and then chopped
• Rotate nucleus 180 degrees and continue creating the divide and conquer trough
• Stabilize eye and just move the needle with the foot pedal going to foot position 3 to cut the nuclear material
• Instead of going for another quadrant, just chop nucleus into two halves
• Bury tip going momentarily into foot position 3 and back into foot position 2 to hold onto the nucleus
  • Again burying tip to divide into two halves
• then chop one of the halves varying tip to 3 and back to 2 and then chop
  • so the foot position 2 purpose is to hold the nuclear material and to use the second instrument to cleave and pull towards the paracentesis
  • Continue burying tip again and grab a piece of material to the center at the iris plane to prepare for emulsification

Emulsification

• Emulsify the nucleus and note active use of second instrument pulling material towards tip and flipping material off the tip to prevention complete occlusion of nucleus onto the needle for more than a moment
• Do not build up a vacuum in the tubing that will create post occlusion surge

Aspiration

• Move nuclear material easily so that it can be grabbed with the needle then pushing with second instrument to push the phaco material in front and off of the tip so that it can be easily emulsified and aspirated
• Position other half at another angle which allows for easy placement to grab and proceed to chop a piece of that bringing it centrally again at the iris plane
• Continue technique of using second instrument to tease material so that it is not stuck on nucleus
• Again another chop, burying tip at foot position 3 for about a second then back to foot position 2.
• Bring piece centrally and use second hand piece instrument to gently push the nucleus off tip so that you do not get full occlusion
• Continue technique, back on material with needle, varying on foot position 3 and back to 2 frequently with a tapping or you can use a pulse mode or burst mode to get little bursts of phaco power that allows better control and not add too much energy to the eye.
• With remaining nuclear piece, remove phaco needle and replace with an irrigation/aspiration (I/A) tip to grab piece
• Use second instrument to push or smoosh remaining material into the tip opening