A comparative study of divide and conquer, stop and chop and phaco chop techniques of nucleotomy in phacoemulsification

Abstract

Phacoemulsification is a variant of extracapsular cataract extraction surgery which is the gold standard treatment modality for cataract surgery nowadays. The common nucleotomy techniques of phacoemulsification are divide and conquer, stop and chop and phaco chop.Aim of this studyto compare different techniques of nucleotomy during phacoemulsification with respect to corneal endothelial cell loss, central corneal thickness (CCT) and comment on their merits and demerits. 60 patients undergoing cataract surgery by phacoemulsification were randomly divided into three groups of 20 each (Group A, B and C) who underwent nucleotomy by divide and conquer, stop and chop and phaco chop technique respectively. The preoperative endothelial cell density and central corneal thickness were recorded using Topcon SP3000P non-contrast specular microscope. All patients were followed up at 1, 4 and 12week after surgery and evaluated for vision, slit lamp examination, endothelial cell count and central corneal thickness.The age group of patients studied was 50-80 years, where maximum number of patients were in 51-60 years age group. Out of 60 patients, most common morphological type of cataract was nuclear (40%) cataract followed by cortico-nuclear (36.67%) cataract. After 1 week of surgery, drop in endothelial cell density was 7.06% in Group A, 6.49% in Group B and 6.84% in Group C patients. A further slight decrease in endothelial cell count was recorded during 4week and on final follow up visit at 12 weeks after cataract surgery, there was an endothelial cell loss of 9.51%, 10.9% and 11% in Group A, B and C respectively. The central corneal thickness at 1postoperative week increased by 2.75%, 2.35% and 2.20% in group A, B and C respectively. Further evaluation of CCT at 4and 12 week after surgery showed the values to be almost same as preoperative values. The rate of complications, which mainly included postoperative keratitis, mild anterior uveitis and cystoid macular edema, were found to be almost the same in all the three study groups.All the three nucleotomy techniques of phacoemulsification i.e divide and conquer, stop and chop and phaco chop are equally efficacious in terms of CCT changes, endothelial cell loss and complications rate in the hands of an experienced surgeon.