Comparison between phaco-chop, Comparison between phaco-chop, divide-conquer and stop & chop divide-conquer and stop & chop

phaco-technique according to the phaco-technique according to the cataract densitycataract density

Hae ri Yum, M.D., Man Soo Kim, M.D.Hae ri Yum, M.D., Man Soo Kim, M.D.Eun Chul Kim, M.D.Eun Chul Kim, M.D.

Department of Ophthalmology and Visual Department of Ophthalmology and Visual Science, Science,

The Catholic University of KoreaThe Catholic University of Korea

No author has any financial or proprietary No author has any financial or proprietary interest interest

in any materials or methods mentionedin any materials or methods mentioned

IntroductionIntroduction

Phacoemulsification was the technique that was Phacoemulsification was the technique that was

performed in almost all cataract surgery. performed in almost all cataract surgery. When phacoemulsification was first introduced, When phacoemulsification was first introduced,

the nucleus was not divided and the phaco-the nucleus was not divided and the phaco-

emulsification probe was used to sculpt and emulsification probe was used to sculpt and

consume the nucleus. consume the nucleus. Compared with extracapsular cataract extraction,Compared with extracapsular cataract extraction,

phacoemulsification in associated with additionalphacoemulsification in associated with additional

potential risks of corneal endothelial cell damage.potential risks of corneal endothelial cell damage.

PurposePurpose

To compare the intraoperative and short-term To compare the intraoperative and short-term postoperative outcomes of cataract surgery postoperative outcomes of cataract surgery performed with 3 different types of the phaco-performed with 3 different types of the phaco-technique (phaco-chop, divide-conquer and technique (phaco-chop, divide-conquer and stop & chop) under microcoaxial or stop & chop) under microcoaxial or conventional cataract surgery according to the conventional cataract surgery according to the cataract density.cataract density.

Materials & MethodsMaterials & Methods

90 cataract eyes with nuclear density from Grade 90 cataract eyes with nuclear density from Grade 2 to 42 to 4

Cataract density Cataract density (NO2 ,NO3, NO4)(NO2 ,NO3, NO4)

Phaco-ChopPhaco-Chop Divide-ConquerDivide-Conquer Stop & ChopStop & Chop

Materials & MethodsMaterials & Methods

Intraoperative measurementsIntraoperative measurements Effective phacoemulsification time (EPT)Effective phacoemulsification time (EPT) Mean cumulative dissipated ultrasound energy (CDE)Mean cumulative dissipated ultrasound energy (CDE) Total balanced salt solution (BSS) useTotal balanced salt solution (BSS) use

Clinical measurements Preoperative, 1-day postoperative, 1,2-month Preoperative, 1-day postoperative, 1,2-month

postoperativepostoperative Best corrected visual acuity (BCVA)Best corrected visual acuity (BCVA) Central corneal thicknessCentral corneal thickness Endothelial cell countEndothelial cell count

ResultsResults

No significant difference between groups

ResultsResults

EPT: effective phacoemulsification timeCDE: mean cumulative dissipated ultrasound energyBSS: balanced salt solution

CDE(%) P value0.0030.033

*Tukey HSD and Duncan test

 

BSS use (ml) 0.017

P value

*Tukey HSD and Duncan test

 

0.048

EPT(sec) P value<0.001

0.009

*Tukey HSD and Duncan test

 The phaco-chop technique can provide more effective lens

removal than divide-conquer and stop & chop phaco

technique with lower phacoemulsification time and energy

in the mature cataract.

ResultsResults

Endothelial cell count loss rate (%)

*Tukey HSD and Duncan test 

Nuclear opacity

Although the mean endothelial cell loss was less in

phaco-chop groups than those in divide-conquer and

stop & chop groups , the difference between groups was

not significant statistically.

ResultsResults

CCT change (%)

*Tukey HSD and Duncan test 

Nuclear opacity

CCT: central corneal thickness (μm)

Although the central corneal thickness increased after

phacoemulsification , there was less change in phaco-chop

than divide-conquer and stop & chop , the difference was not

significant.

ResultsResults

No significant difference between groups

ConclusionConclusion

The phaco-chop technique can provide more effective The phaco-chop technique can provide more effective

lens removal than divide-conquer with lower lens removal than divide-conquer with lower

phacoemulsification time and energy in the mature phacoemulsification time and energy in the mature

cataract.cataract.

However, the phaco-chop, divide-conquer and stop & However, the phaco-chop, divide-conquer and stop &

chop technique may be all effective for both of chop technique may be all effective for both of

microcoaxial and conventional incision cataract surgery.microcoaxial and conventional incision cataract surgery.

There is an advantage of phaco-chop over divide-conquer There is an advantage of phaco-chop over divide-conquer

and stop & chop in both CCT and ECC change but this and stop & chop in both CCT and ECC change but this

advantage is no significant difference statistically.advantage is no significant difference statistically.