Question from a reader: how to use the Akahoshi prechopper?

By Rob Melendez, MD

This was a question from one of our readers:

Recently I saw your video on-line regarding the Akahoshi prechopper. I had a few questions regarding the procedure. How deep are you going on the prechopper? If a surgeon uses this on a borderline 1+ to 2+ lens, what would they generally see if it’s a bit gummy? Finally, are you completely eliminating the sculpt and going straight to quadrant removal? Would you ever recommend a bit of sculpt and then prechopping (e.g. 3++ NS). Thank you for your time and consideration. I appreciate the shared knowledge and any further expertise you may share.

Thanks for your email. The Akahoshi prechopper is best used for 2-3+ NS. The 1+ NS is too soft for this instrument. The depth is about 60%. I am eliminating the sculpt mode. This technique cuts down on the phaco time. Once the 4 quadrants are generated, they are easily removed. I also perform a hydrodelineation in addition to the hydrodissection. The hydrodelineation provides additonal protection.

Thanks,
Rob Melendez, MD