Comparison of Surgical Parameters and Outcomes According to the Phacoemulsification Technique

Soa Kim; Dong Ah Ko; Jae Yong Kim; Myoung Joon Kim; Hung Won Tchah

doi:10.3341/jkos.2013.54.9.1353

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Kim, Ko, Kim, Kim, and Tchah: Comparison of Surgical Parameters and Outcomes According to the Phacoemulsification Technique

Original Article

J Korean Ophthalmol Soc 2013;54(9):1353-1358.

Published online: 7 September 2013

DOI: https://doi.org/10.3341/jkos.2013.54.9.1353

Comparison of Surgical Parameters and Outcomes According to the Phacoemulsification Technique

Soa Kim, MD, Dong Ah Ko, MD, Jae Yong Kim, MD, PhD, Myoung Joon Kim, MD, PhD, Hung Won Tchah, MD, PhD

Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Address reprint requests to Hung Won Tchah, MD, PhD Department of Ophthalmology, Asan Medical Center, #88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea Tel: 82-2-3010-3674, Fax: 82-2-470-6440 E-mail: hwtchah@amc.seoul.kr

∗ This study was presented as a narration at the 106th Annual Meeting of the Korean Ophthalmological Society 2011.

Received 25 May 20124 October 2012 Accepted 25 June 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To compare intraoperative parameters and postoperative results between divide-and-conquer and multiple pha-co-chop technique.

Methods

Two different techniques were performed by one operator on the patients with bilateral cataract. One eye was phacoemulsified by divide-and-conquer technique (D eye), and the other was performed by multiple phaco-chop technique (M eye). Changes of central corneal thickness during the operation, total phaco-time and phaco-energy were measured.

Results

Total 29 patients were included. The change of central corneal thickness were 8.4 ± 11.8 μ m in D eye and 11.5 ± 16.7 μ m in M eye, which showed no significant difference (p = 0.350) and total phaco-time were 70.1 ± 32.9 seconds in D eye and 71.1 ± 55.0 seconds in M eye, which also showed no significant difference (p = 0.689). However, phaco-energy were 12.4 ± 8.3 power × s in D eye and 8.4 ± 9.9 power × s in M eye, and this result showed significantly larger energy when using divide-and-conquer technique (p < 0.001).

Conclusions

There was no significant difference in change of central corneal thickness and phaco-time between two techniques, divide-and-conquer and multiple phaco-chop technique. However, significantly smaller phaco energy was used by multiple phaco-chop technique compared with divide-and-conquer technique.

Keywords: Cataract surgery, Divide and conquer, Multiple phaco-chop, Phacoemulsification, Phaco energy

References

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Figure 1.

Multiple phaco-chop technique. (A) split the nucleus along its natural cleavage planes with second instrμ ment, chop-per, while holding the nucleus with high vacuμ m. (B) rotate the split nucleus. (C) split the nucleus in different direction using the same process with (A) Repeat a and (B) to split the nucleus in several different direction, then emulsify the nucleus mainly using negative pressure.

Figure 2.

Comparison of surgical parameters and outcomes according to the phacoemulsification technique. DivC = divide and conquer technique; MultiPC = multiple phaco-chop technique.

Table 1.

Patient baseline characteristics

	DivC (n = 29)	MultiPC (n = 29)	p-value*
Sex (M/F)	0.38	0.38	1
Age (years) ECD (cell/mm²)	71.8 ± 9.88 2718 ± 576	71.8 ± 9.88 2653 ± 405	1 0.405
Nuclear sclerosis^†	3.30 ± 1.09	3.37 ± 0.99	0.633
Axial Length (mm)	23.41 ± 0.87	23.41 ± 0.86	0.982
ACD (mm)	2.95 ± 0.47	2.97 ± 0.45	0.610
Preop VA^‡ (log MAR)	0.46 ± 0.32	0.45 ± 0.32	0.721

Values are presented as mean ± SD.

SD = standard deviation; DivC = divide and conquer technique; MultiPC = multiple phaco-chop technique; ECD = endothelial cell density;

ACD = anterior chamber depth.

^* Paired t-test;

^† LOCS III grading;

^‡ log MAR.

Table 2.

Comparison of surgical parameters and outcomes according to the phacoemulsification technique by nucleus density

Soft nucleus* (<N4)	DivC (n = 18)	MultiPC (n = 18)	p-value^‡
Infusion volμ me (ml)	64.3 ± 19.3	62.3 ± 20.8	0.535
Total phaco time (s)	64.0 ± 37.7	56.1 ± 34.3	0.184
Aver phaco power (%)	16.8 ± 4.5	10.5 ± 7.4	0.008
CDE (power × s)	11.0 ± 5.4	6.3 ± 6.4	0.004
Postoperative CCT increase (μ m)	10.2 ± 16.6	8.7 ± 16.4	0.554

Hard nucleus^† (≥ N4)	DivC (n = 8)	MultiPC (n = 8)	p-value^‡
Infusion volμ me (ml)	76.5 ± 35.1	83.7 ± 26.7	0.345
Total phaco time (s)	94.7 ± 38.5	114.7 ± 68.8	0.263
Aver phaco power (%)	21.7 ± 7.8	17.4 ± 6.3	0.161
CDE (power × s)	18.3 ± 13.5	16.9 ± 15.4	0.463
Postoperative CCT increase (μ m)	15.3 ± 20.2	18.3 ± 19.5	0.674

Values are presented as mean ± SD.

SD = standard deviation; DivC = divide and conquer technique; MultiPC = multiple phaco-chop technique; CCT = central corneal thickness; CDE = cμ mulative dissipitated energy.

^* <LOCS III grade N4;

^† ≥ LOCS III grade N4;

^‡ Wilcoxon Matched-Pairs Signed-Ranks test.

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