Drill-and-prechop technique: modification of the drill-and-crack technique for mature cataracts

There are some techniques for disassembly of hard nuclear. It is challenging in hard cataract surgery through microincision. The classic chop or prechop techniques often do not succeed,resulting in incomplete nuclear segmentation. The authors describe a new chop technique for removing hard nucleus cataracts in coaxial microincisional cataract surgery. We create a deep hole (drill) in the central nucleus with the phaco tip and divide the nucleus (prechop) with the Nagahara chopper and the modified capsulorhexis forceps inside the hole. The chopper and the modified capsulorhexis forceps are spread apart laterally after they approach at the center of the nucleus, to create a complete fracture across the entire nucleus. Since January 2022, we have completed 27 eyes of 25 patients with hard nucleus cataract using this technique. Complete segmentation of the hard nuclear into two hemispheres was implemented with this drill and prechop technique in all cases. The effective phaco time and ultrasound energy decreased. No intraoperative complication such as iris injury, anterior capsule tears, zonulysis, or posterior capsule rupture with vitreous loss occurred during surgery. This technique simplifies the previous prechop techniques especially for hard nucleus in microincisional cataract surgery. The technique is efficient, safe and simple.