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Woodcutter’s Technique

Phacoemulsification procedure basically involves removing nucleus by dividing it in small fragments. For grade III & IV nuclei, chopping technique is considered as best amongst existing techniques. Author wants to highlight a new approach to divide such nuclei & has named this new technique as Woodcutter’s Technique.

When a woodcutter wants to divide a wooden log into two pieces, he first nails a chisel in the log. Some distance away from the chisel, he hammers on the log with an axe; goes on hammering, slowly approaching chisel. As soon as he is very close to the chisel, the wooden log automatically gets cracked into two vertical fragments (as shown in fig.1). Woodcutter’s technique is based on same principle. In cracking technique, instruments are in centre but a crack extends till periphery & till bottom. In cutting technique, cleavage or crack never extends beyond the passage of instruments. In cracking technique there are some pre requisites. Thickness of axe is important for crack to develop & depth (at least 60%) at whih axe goes is also important. Similarly the phaco tip is thick & it should go (60% thickness of nucleus) deep.

In karate chop technique, we normally hold the nucleus with phacotip & then move chopper towards the phaco tip. As against this, in Woodcutter’s, chopper is placed at same place & not moved. Instead, the phaco tip, which is holding the nucleus, is moved towards the chopper (with phaco on). This automatically divides the nucleus in two fragments, when phaco tip approaches near the chopper. Thus chopper acts like a chisel & phaco tip like an axe (as shown in fig.2). Remember that, phaco sleeve should be 1.5 mm behind the outermost point of phaco tip & you have to move phaco tip towards chopper with phaco on. If you keep distance very small, depth of phaco tip entering inside nucleus is less & division becomes slightly difficult. For a harder nucleus this distance should be more. If the distance is more, the irrigation may stop even if you withdraw phaco probe slightly. No sculpting or grooving in nucleus is required. It is easier to master woodcutter’s technique with clear corneal incision. The advantages of Woodcutter’s technique are that ‘ it is fast to perform, you are away from posterior capsule as well as zonules, simple & easy even for phaco beginners and a boon especially for nuclei which are not so soft.

How to learn?
The sleeve of the phaco tip should be pulled back, so as to expose a 1.5-to2.mm area. Hard nuclei require more exposure of phaco tip. Then the phaco tip is introduced into the anterior chamber. Through a side port incision, the chopper is also introduced into the anterior chamber. With the help of the chopper, the nucleus is pushed about 1 mm away in the direction opposite to the incision site and the phaco tip is embedded in the nucleus at an angle of 70 to 80 degrees. I recommend a clear corneal incision rather than a scleral one, as it would be difficult to hold the phaco tip almost vertically through a scleral tunnel. Then the chopper is buried at the capsulorhexis edge. With the phaco on, the tip is moved toward the chopper, and that’s all – your nucleus splits like a log under the axe.