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Phaco Tips > Phaco Tip 130: Can A Chopper Be Dangerous?
Surgeons formerly wondered if a "sharp edge"
of a dense nucleus could rupture the posterior capsule. The answer, published
8 years ago in a Phaco Tips column and subsequently demonstrated videographically
by Robert Osher, M.D., was that it cannot. Choppers, however, are a different
story.
Even a smooth chopper can tear the posterior capsule
in the following manner. During phaco, and most commonly during nuclear
segment removal, the chopper may be placed behind a nuclear segment in
order to prevent forward movement of the posterior capsule during either
a fluid surge or a period of infusion misdirection. During either of these
events, a forward shift of the posterior capsule can occur with resultant
depression of the posterior capsule by the chopper. If the chopper is
moved in a horizontal direction at that time, it is entirely possible
to tear the posterior capsule.
Here’s how to avoid this uncommon but real complication.
After using the chopper to segment the nucleus, remove the chopper and
replace it with a blunt-tipped spatula. Use the spatula to protect the
posterior capsule during nuclear segment removal, and the risk of chopper-induced
PC tear is eliminated.
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