Minimizing Endothelial Cell Loss in Hard Nucleus Cataract Surgery: Efficacy of the Eight-Chop Technique

Abstract

Objectives: To estimate the efficacy of the eight-chop technique in phacoemulsification surgeries for patients with hard nucleus cataracts by investigating the reduction of corneal endothelial cell density (CECD) after phacoemulsification and intraoperative parameters. Methods: Patients were categorized into three groups (Grade IV, IV plus, and V) according to the hardness of their lens nuclei. Surgeries were performed using the eight-chop technique. Key intraoperative metrics (operative time, phaco time, aspiration time, cumulative dissipated energy [CDE], and fluid volume used) were measured. Pre- and postoperative assessments included corrected-distance visual acuity, intraocular pressure (IOP), central corneal thickness, variation in the size of the endothelial cells, percentage of hexagonal cells, and CECD. Results: Overall, 89 eyes from 67 patients with cataracts were evaluated. The mean operative time, phaco time, aspiration time, CDE, and fluid volume used across Grades IV, IV plus, and V were 10.5 min, 38.9 s, 135.6 s, 19.2, and 53.0 mL, respectively. At 19 weeks postoperatively, the CECD decreased by 0.2%, 6.8%, and 9.6% for Grades IV, IV plus, and V, respectively, with an average decrease of 3.7%. Significant reductions in postoperative IOP were observed across all groups compared with preoperative IOP (p < 0.01). Loss of CECD significantly correlated with phaco time, CDE, and fluid volume (p = 0.027, p < 0.01, and 0.034, respectively). Conclusions: The eight-chop technique in phacoemulsification for hard nucleus cataracts resulted in minimal CECD loss. It may provide an effective surgical solution for patients with hard nucleus cataracts.

Keywords: corneal endothelial cell; eight-chop technique; hard nucleus cataracts; phacoemulsification.

Figure 1

Grade IV, IV plus, and V cataracts. Frontal views of Grade IV nucleus (a), Grade IV plus nucleus (b), and Grade V nucleus (c). Grade IV nucleus, completely amber (d). Grade IV plus nucleus, mostly amber but some brown (e). Grade V nucleus, mostly brown but some black (f).

Figure 2

Lens nucleus segmentation of Grade V cataract. (a) First, the lens nucleus is divided into hemispheres using the Lance-chopper. (b) Thereafter, a 90° rotation of the lens nucleus is performed, and it is divided into quadrants. (c) The lens nucleus that has been divided into quadrants is rotated again at a 45° angle and then divided into six segments. (d) Lastly, the remaining quadrants of the lens nucleus are also divided to complete the eight-part segmentation.