Comparison of the phaco chop and drill‐and‐crack techniques for phacoemulsification of hard cataracts: A fellow eye study

Abstract

To quantify the intraoperative parameters and postoperative outcomes after using the phaco chop technique in one eye and drill-and-crack technique in the other eye in patients with bilateral dense brunescent cataract. Methods: The Lens Opacities Classification System III grading system was used to select 132 eyes of 66 patients with bilateral nuclear opalescence (NO) grade NO4 or grade NO5. One eye in each patient with bilateral dense brunescent cataract was subjected to phacoemulsification using the phaco chop technique, while the other eye was subjected to phacoemulsification with the drilland-crack technique for nucleus disassembly. The intraoperative parameters were quantified. Surgical outcome was assessed preoperatively and 1 day, 4 weeks and 12 weeks postoperatively, and the outcomes of the two techniques were compared. Results: There was no significant difference between the techniques in operative parameters [cumulative dissipated energy (p = 0.74), surgical time (p = 0.68) or surgical difficulty during nucleus disassembly (p = 0.80)]. There was no significant difference in the postoperative change in central corneal thickness between the techniques at day 1, 4 weeks and 12 weeks or in corneal endothelial cell density loss at 4 and 12 weeks (p > 0.05). There was no significant difference between the techniques in the mean corrected distance visual acuity (logarithm of the minimum angle resolution) at 4 weeks postoperatively (p = 0.25). Conclusion:The phaco chop and drill-and-crack techniques are equally effective for disassembly of hard NO4 and NO5 cataracts.

Efficacy and safety of the eight-chop technique in phacoemulsification for patients with cataract

“…27 Previous studies have reported a 5% to 16% decrease in corneal endothelial cell density after cataract surgery in the first few postoperative months; however, in this study, the decrease was 0.9%, 1.0%, and 5.3% in the Grade II, III, and IV groups, respectively, with no significant difference after 19 weeks in all groups. 18,19,21,24–26,28 These results indicate that the 8-chop technique may be advantageous in surgical invasion of the intraocular tissue.…”

“…[18][19][20][21][22][23][24] Even in cases with hard lens nuclei, the Lance-chop technique can be completed in less than 10 minutes, which may be shorter than the phaco-chop technique, which reportedly takes 12 minutes. 25 The 8-chop technique had a lower phaco time and CDE than other techniques; it also had an extremely low volume of fluid, that is, one-third to one-fourth of that used for other techniques. [18][19][20][21][23][24][25][26] In particular, the use of a low volume of fluid means that ultrasound and irrigation/aspiration tips are inserted into the eye for a short period, which may have little impact on ocular tissues other than corneal endothelial cells.…”

Comparison of the reverse chopper-assisted prechop and phaco-chop nucleotomy techniques during phacoemulsification for cataracts with grade III nuclei: a randomized controlled trial

“…The analysis revealed the surgeon used the reverse chopper to perform lens splitting manually without ultrasound energy. In contrast, excessive US energy was required to form a deep crater to bury the needle into the endonucleus for nucleus fragmentation in phaco-chop group ( 5 , 22 ). These results were consistent with the previous reports during grade IV hard nucleus cataract surgery, small pupil cataract surgery and high myopia associated cataract surgery in our eye center ( 16 - 18 ).…”

“…Currently, phacoemulsification surgery is the standard treatment for cataract and lens fragmentation is considered the critical step in the surgery ( 3 ). In recent years, several different lens splitting techniques in phacoemulsification have been developed, such as in situ fracture, divide-and-conquer, stop-and chop, and phaco-chop techniques, among which phaco-chop is the most classic and popular one ( 4 , 5 ). However, the learning curve of phaco-chop nucleotomy technique is long, as it requires good hand-foot coordination from the surgeon and frequent conversion between ultrasound (US) and negative pressure ( 6 ).…”

Application of prechop technique in phacoemulsification for cataract patients with highly liquefied vitreous: a retrospective study

“…If a patient received bilateral surgery, only data from the left eye was included for analysis. Of them, 25 eyes that received manual prechop to split the nucleus before phacoemulsification were included in the prechop group, and 29 eyes that received phaco-chop [ 18 ] during cataract surgery were included in the control group. All patients were fully informed of the possible risks of the surgery after finishing preoperative medical examinations.…”