A Prechop Technique Using a Reverse Chopper

<i>Purpose</i>: To describe a manual prechop technique for splitting the nucleus of the lens using a recently developed reverse chopper. <i>Methods</i>: During the process, the reverse chopper and the Nagahara chopper are placed diagonally in the peripheral area of the nucleus of the lens after capsulorhexis. The reverse chopper and the Nagahara chopper then are pushed horizontally toward each other so they meet at the center of the lens to split the nucleus of lens into 2 parts. <i>Results</i>: In all cases, the reverse chopper was effective during the prechop procedure for hard nuclei, the nucleus of the lens remained <i>in situ</i> during the chopping process, and the reverse chopper did not retract the suspensory ligament in patients in whom the ligament was fragile. During the prechop procedure, no capsule breakage occurred, and the time and energy required for effective phacoemulsification were reduced significantly. <i>Conclusions</i>: The prechop technique using the reverse chopper can be applied for cases with grade III–V nuclei, overripe nuclei, and fragile suspensory ligaments. The procedure is simple, and the learning curve is not steep.

研究目的：介绍一种采用新近研发的反向劈核器（reverse chopper）劈开晶状体核的手动预劈核技术。
手术方法：完成晶状体前囊膜连续环形撕囊术（capsulorhexis）后，将反向劈核器与永原劈核器（Nagahara chopper）斜向放置于晶状体核的周边区域；随后使两把劈核器沿水平方向相向推进，于晶状体核中央处汇合，从而将晶状体核劈分为两半。
研究结果：所有病例中，反向劈核器用于硬核预劈核操作时均效果良好；劈核过程中晶状体核保持原位（in situ），且在悬韧带脆弱的患者中，反向劈核器未造成悬韧带牵拉回缩。预劈核操作全程未出现囊膜破裂，有效超声乳化术（phacoemulsification）所需的时间与能量均显著降低。
研究结论：采用反向劈核器的预劈核技术可应用于Ⅲ~Ⅴ级硬核晶状体核、过熟期晶状体核以及悬韧带脆弱的手术病例。该操作简便易行，学习曲线平缓。