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      The Stop and Press Technique; an Occlusion Free Stop-and-Chop Technique in Cataract Patients with Soft to Moderate Nuclei

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          Abstract

          The stop-and-chop technique, which involves occlusion and chopping using vacuum to stabilize the nucleus, is an excellent combination of the divide-and-conquer and phaco-chop techniques. However, effectively chopping an un-solid (soft to moderate) nucleus is not easy, since the optimal vacuum to hold an un-solid nucleus is often associated with breaking of occlusion and aspiration of the nucleus. We modified the stop-and-chop technique such that occlusion and tight nucleus holding using ultrasound (US) power is not necessary. After completing the central groove and cracking the nucleus into two hemi-sections, the right nucleus half is chopped without nucleus rotation and occlusion. The right hemi-nucleus is stabilized by pressing against the right sac with the US tip without occlusion. Since this technique can reduce the risk of nucleus perforation and posterior capsular rupture, the surgeons can place the US tip firmly in a deep position, which provide safe and efficient nucleus division.

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          Most cited references14

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          Comparison of phaco-chop, divide-and-conquer, and stop-and-chop phaco techniques in microincision coaxial cataract surgery.

          To compare the outcomes of coaxial microincision cataract surgery (MICS) performed with 3 phacoemulsification techniques (phaco-chop, divide-and-conquer, and stop-and-chop) according to cataract density.
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            Stop and chop phacoemulsification

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              Phaco rolling technique.

              We describe a phacoemulsification technique for soft and medium-hard cataracts to decrease phaco time and enhance the safety of the procedure. After conventional hydrodissection and hydrodelamination are performed, a 15- or 30-degree phaco tip is positioned on the peripheral lens beside the capsulorhexis edge and in contact with the nucleus-epinucleus interface. The lens is then aspirated onto the phaco tip. Phacoemulsification is started with the ultrasound energy level limited to 15% to 25% depending on the nuclear hardness and with linear aspiration power up to 250 mmHg. The phaco tip is slightly displaced to the vertex of the pupil to keep it occluded, and the lens is rotated. The phaco tip is placed in the same area and a modified manipulator used to keep the lens in a horizontal position during rotational movement. The small, hard, central nucleus is usually emulsified at the end.
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                Author and article information

                Journal
                Clin Ophthalmol
                Clin Ophthalmol
                opth
                Clinical Ophthalmology (Auckland, N.Z.)
                Dove
                1177-5467
                1177-5483
                10 October 2022
                2022
                : 16
                : 3283-3287
                Affiliations
                [1 ]Department of Ophthalmology, Nojima Hospital , Kurayoshi-city, Japan
                [2 ]Department of Ophthalmology and Visual Science, Tottori University , Yonago-city, Japan
                Author notes
                Correspondence: Kazuki Matsuura, Nojima Hospital , 2714-1, Sesaki-machi, Kurayoshi-city, Tottori Prefecture, 6820863, Japan, Tel +81-858-22-6231, Fax +81-858-22-6843, Email matsuura.kzk@gmail.com
                Author information
                http://orcid.org/0000-0002-9630-6754
                Article
                379325
                10.2147/OPTH.S379325
                9553315
                36237494
                d1399594-150d-4a88-904c-648b023a5986
                © 2022 Matsuura and Takanashi.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                : 20 June 2022
                : 12 September 2022
                Page count
                Figures: 2, References: 14, Pages: 5
                Categories
                Methodology

                Ophthalmology & Optometry
                cataract surgery,divide-and-conquer technique,stop-and-chop technique,power free phacoemulsification,stop-and-press technique

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