When dealing with dense nuclei, more pressure needs to be applied in order to divide the nucleus. However, when using choppers that are suitable for soft nuclei, the added pressure sometimes causes the nucleus to flip or shift in the capsular bag. This is true even for very sharp choppers. What makes the Fonseka chopper so unique is that there is a sharp groove at the back of the tip. This groove makes the inner-cutting edge shorter than the front of the tip and allows the chopper to anchor and then pivot to penetrate the nucleus. First, I use the front of the tip to initially penetrate the center of the nucleus. Advancing the chopper forward slightly, I angle the chopper downward so that the shorter end of the tip sinks down into the nucleus. Afterward, I insert the phaco tip in the same opening and divide the nucleus by moving the chopper and phaco tip apart from each other. The chopper is advanced forward and back until the nucleus in completely divided. In cases of small pupils, the notch at the front of the chopper can be used to temporarily retract the pupil. I then use the inner-cutting edge of the chopper to divide the nucleus into small fragments. These fragments can be easily fixated by the heel of the chopper during emulsification. With this new chopper, I have had great success with hard nuclei grades 3 to 5.
by Charith Fonseka on 19 Aug 2014