Reduction of Cumulative Dissipated Energy, Phaco Times, and Fluid Use With Nuclear Prechopping Compared With Divide-and-Conquer Technique
Narrative Responses:
Purpose
Evaluation of the use of mechanical nuclear prechopping to reduce phaco power parameters. Patients were randomized to either the prechopping group or divide and conquer technique. Reduction of phaco usage has been associated with less post op inflammation and quicker recovery times.
Methods
81 cases were evaluated with respect to phaco machine parameters which included CDE, phaco time, fluid usage and average phaco power. Only grade 1 and 2 nuclear cataracts were evaluated. Prospective evaluation of all parameters were collected and evaluated. Cases were matched only by nuclear hardness. The two groups were either a)(30) prechopped with an Akahoshi prechopper or b) (51) routine divide and conquer. Cases were randomized into either group by the surgeon on the basis on suitability for prechopping and availability of the prechopper.
Results
Mechanical prechopping reduced CDE (cumulative dissipated energy) by 79% ( p<0.01) and phaco time by 57%.( p,0.01) when compared to the divide and conquer technique. It also reduced fluid usage by 27%.(p<0.05) There were no cases where CDE or phaco power was reduced to 0. Aspiration time did not increase and in fact was reduced by 25% ( p<0.05). When evaluating fluid use in position 2 only, ie cortical clean up, there was much less difference between the two groups.
Conclusion
Mechanical prechopping is an effective technique to reduce phaco power usage in routine cataract surgery. This may translate into quicker visual recovery and less postoperative recovery. Further work needs to be done in respect to the outcomes.