Oblique Chop: A Novel Hook and Lock Technique for Single Step Nuclear Fracture in Cataract Surgery

Purpose: To introduce and evaluate the efficacy of oblique chop technique designed to achieve single-pass nucleus division by leveraging both the tip and proximal arm of the chopper for simultaneous anchoring and splitting. Patients and Methods: The oblique chop technique was performed in 60 eyes with cataracts ranging from nuclear sclerosis grades NS1 to NS3 (NS1: n=20, NS2: n=20, NS3: n=20). A side port incision was created between 90° and 100° relative to the main port to optimize the mechanical advantage for the hook-and-lock motion. During chopping, the tip of the chopper engages the central nucleus while the arm locks laterally, creating a hook-and-lock configuration that allows a single synchronized motion to fracture the nucleus without rotation or repeated attempts. The technique can be performed using a standard blunt chopper. Primary intraoperative parameters included single-attempt nuclear division rate, phacoemulsification time, cumulative dissipated energy (CDE), and capsular bag stability. Postoperative parameters included best-corrected visual acuity (BCVA), endothelial cell loss, and complication rates. Results: Complete nuclear division was achieved in 56 of 60 eyes (93.3%) overall-19/20 eyes (95%) in NS1, 19/20 eyes (95%) in NS2, and 18/20 eyes (90%) in NS3. Mean absolute phacoemulsification time was 15.0 ± 3.7 seconds, and mean CDE was 5.0 ± 1.4. Mean endothelial cell loss at 1 month was 3.5 ± 0.8%. Mean BCVA improved from 0.78 ± 0.20 logMAR preoperatively to 0.03 ± 0.05 logMAR postoperatively (p < 0.001). No significant intraoperative or postoperative complications were observed. Conclusion: Oblique Chop is a simple, reproducible, and energy-efficient nucleus division technique that utilizes the full mechanical advantage of the chopper, enabling single-pass nucleus division with reduced ultrasound energy and favorable visual outcomes in nuclear sclerosis grades 1-3. Further comparative studies are warranted to validate these findings.