Systematic Transition to Phaco-Chop.

Phaco surgeons initially train in a four quadrant divide and conquer technique. Subsequently, several surgeons transition to chopping techniques due to the perceived advantages of phaco-chop that include lower ultrasound energy and lesser zonular stress. Stop and chop has conventionally been the technique of choice for making this transition. However, the surgeon has to execute a full-fledged chop after the creation of two hemi-segments by the classical trenching and cracking skills already acquired in divide and conquer techniques. Here we describe a set of intermediate steps during four quadrant divide and conquer that breaks down the skills required for chopping and enables the surgeon to sequentially imbibe the required skill sets to make the transition to chop safer and smoother.

Toric implantable collamer lens for keratoconus.

Keratoconus is a progressive non-inflammatory thinning of the cornea that induces myopia and irregular astigmatism and decreases the quality of vision due to monocular diplopia, halos, or ghost images. Keratoconus patients unfit for corneal procedures and intolerant to refractive correction by spectacles or contact lenses have been implanted toric posterior chamber phakic intraocular lenses (PC pIOLs) alone or combined with other surgical procedures to correct the refractive errors associated with keratoconus as an off label procedure with special informed consent from the patients. Several reports attest to the safety and efficacy of the procedure, though the associated corneal higher order aberrations would have an impact on the final visual quality.