A Comparative Study of Central Corneal Thickness and Endothelial Cell Density after Phacoemulsification by ‘Phaco-chop’ and ‘Divide and Conquer’ Techniques

Abstract

Introduction: Phacoemulsification was introduced by Kelman in 1967. It is one of the most important innovations in ophthalmology. This has now been accepted as gold standard surgical procedure for management of cataract. Divide and conquer technique, described by Gimbel, was the first nucleofractis cracking technique developed. Phoc-chop technique was presented by Kunihiro Nagahara in 1993 at the meeting of America Society of Cataract and Refractive Surgery. Aim: To compare the Central Corneal Thickness (CCT) and endothelial cell density after phacoemulsification by ‘phaco-chop’ and ‘divide and conquer’ techniques. Materials and Methods: The study included 100 patients divided into two groups, each including 50 patients; Group A, where Divide and Conquer was performed, and in Group B Phaco-chop was performed. The mean Absolute PhacoTime (APT), mean Endothelial Cell Count (ECC), mean Endothelial Cell Loss (ECL), corneal thickness and the visual acuity were reported in the two groups both preoperative and postoperative. Results: The mean APT in group A was 27.12±10.15 seconds, and in group B was 16.58±5.11 seconds (p=0.0001). The mean ECC at sixth week postoperative in group A was 2102. 14 cells/mm2 and in group B it was 2365.38 cells/mm2 (p=0.003). There was statistically significant ECL following sixth week postoperatively 16.22% in divide and conquer group and 8.51% in phaco-chop group (p-value=0.0001). A significant increase in the CCT was observed at the immediate postoperative week among the two studied groups; 3.16% in group A and 2.34% in group B, which was statistically significant. The postoperative CCT pachymetry values were returned to near preoperative values at one and a half months postoperative. Conclusion: The phaco-chop technique utilises less phaco time and energy without significant effect on the final surgical outcome. Significant and equal ECL occurs after the two studied techniques. APT and nuclear grade have a positive correlation with higher ECL. CCT increases significantly and equally postoperatively following the two techniques.

Phaco-Chop versus Divide-and-Conquer in Patients Who Underwent Cataract Surgery: A Systematic Review and Meta-Analysis

“…20 Furthermore, the total amount of phaco energy delivered into the eye is an important predictor for good vision and clear cornea postoperatively. 7 These results provide valuable insights into the possible advantages of the phaco-chop technique over the divide-andconquer technique. However, it is crucial to consider the study limitations, including non-randomized studies in our meta-analysis, potentially introducing sampling bias.…”

“…Next, three articles were excluded as per our exclusion criteria. Finally, eight studies were included in this review, six prospective randomized controlled trials (RCTs) 7,8,[17][18][19][20] and three observational studies. 9,20,21 A total of 837 patients underwent phacoemulsification.…”

“…6 At the 1993 meeting of the American Society of Cataract and Refractive Surgery, Kunihiro Nagahara presented a technique known as "phaco-chop". 7 With advancements in this technology, incision size, phacoemulsification energy, endothelial cell count (ECC), ultrasound energy dispensed, and cumulative dissipated energy (CDE) have been reduced, and several techniques have been described to optimize phacoemulsification, including phaco-chop and divide-and-conquer. [7][8][9] However, it's unclear if phaco-chop is truly superior when compared to divide-and-conquer.…”

“… 6 At the 1993 meeting of the American Society of Cataract and Refractive Surgery, Kunihiro Nagahara presented a technique known as “phaco-chop”. 7 …”

Incidence of Corneal Inflammation of Varying Severity among Contact Lens Wearers

“…However considering the advantages of the type of lens in terms of wearer comfort and keeping off damaging effects associated with long term deposit formation, no statistically significant difference was noted on occurrence of severe corneal inflammation amongst daily wearers and wearing disposable lenses as opposed to daily wearers using hydrogel lenses. Pseudomonas species are usually considered as damage causing microbial pathogen in contact lens related corneal inflammation, as per the findings of clinical severity scores of the patients who had undergone corneal scrape procedure [24][25][26][27][28][29][30][31][32][33][34].…”