Counter Phaco-Prechop Technique In Hard Cataract
Dina Abdel Monem Ali Ibrahim;
Abstract
Patients and methods:
This is a prospective comparative non-randomized clinical trial evaluating the efficacy and complications of 2 phacoemulsification surgical techniques: Group A: 20 patients using Phaco Counter Prechopping technique; and Group B: 20 patients using Stop and Chop technique. Outcome measures are A) Intraoperativephaco (ultrasound) time, cumulative dissipative energy (CDE)and complications; and B) Post-operative changes in corneal endothelial cell loss, cornea thickness and BCVA at 3 months compared to baseline. We experienced difficulty in acquiring the necessary surgical skills for the Counter Prechopping technique with a high intraoperative complications, thus it was necessary to stop at 14 attempted eyesin group A.
Results and discussion:
In group A (14 eyes) the mean effective phaco time was 59.9±28.96 while in group B (20 eyes) it was 54.09±27.39seconds, statistically insignificant (P-value 0.623).The mean CDE was 32.47 ±12.58 and 30.13 ±10.58 for group A (14 eyes) and B (17 eyes) respectively, (P value 0.616). The ultrasound time in relation to nuclear grading: nuclear grade III,44.21 ±18.53 (24.6-78.9) and 41.07 ±8.11 (30.7-59.8) for group A (9 eyes)and B (15) respectively, (P value 1.00); and nuclear grade IV, 88.14±22.1 and 93.16±28.11 for group A (5)and B (5) respectively,(Pvalue 1.00). The CDE in relation to nuclear grading: nuclear grade III 26.11±11 and 24.86±4.39 for group A and B respectively, (P value 1.00), and nuclear grading IV was 43.9±4.08 and 45.94±3.97 for Group A and B respectively, (P-value 1.00). In nuclear cataract grade III, meanpostoperative percentage endothelial cell loss at 3 months was 10.88 ±3.33 and 11.86 ±2.29 % for group A and B respectively, (P-value 0.091).In nuclear grade IV, mean postoperative percentage endothelial cell loss at 3 months was 17±2.23and 18±2.12 % for group A and B respectively, (P-value 0.091). No significant differenceswere found between both groups in the postoperative (3 months) BCVA nor the increase in the mean corneal thickness with nuclear grade III or IV. Intraoperatively6 eyesin group A had tears in the posterior capsule compared to 3 eyes in group B, this was statistically significant between groups in nuclear grade III (P value 0.027).Regarding the length of the procedure in the operative theatre, there was no recognized difference between two groups, except for cases in group A-3 and B-2, where there were complications, the whole lengh of the operation was 7 minutes more than other cases .
Conclusion:
In general our small experience with the counter prechop technique showed a high rate of complications with a difficultly in acquiring the necessary surgical skills with no beneficial outcomes. Caution for surgeons interested in adopting this technique, is adviceed.
Key Words: Phacoemulsification- Phaco Prechop- Combo Prechopper- -Counter Prechop- Akahoshi
This is a prospective comparative non-randomized clinical trial evaluating the efficacy and complications of 2 phacoemulsification surgical techniques: Group A: 20 patients using Phaco Counter Prechopping technique; and Group B: 20 patients using Stop and Chop technique. Outcome measures are A) Intraoperativephaco (ultrasound) time, cumulative dissipative energy (CDE)and complications; and B) Post-operative changes in corneal endothelial cell loss, cornea thickness and BCVA at 3 months compared to baseline. We experienced difficulty in acquiring the necessary surgical skills for the Counter Prechopping technique with a high intraoperative complications, thus it was necessary to stop at 14 attempted eyesin group A.
Results and discussion:
In group A (14 eyes) the mean effective phaco time was 59.9±28.96 while in group B (20 eyes) it was 54.09±27.39seconds, statistically insignificant (P-value 0.623).The mean CDE was 32.47 ±12.58 and 30.13 ±10.58 for group A (14 eyes) and B (17 eyes) respectively, (P value 0.616). The ultrasound time in relation to nuclear grading: nuclear grade III,44.21 ±18.53 (24.6-78.9) and 41.07 ±8.11 (30.7-59.8) for group A (9 eyes)and B (15) respectively, (P value 1.00); and nuclear grade IV, 88.14±22.1 and 93.16±28.11 for group A (5)and B (5) respectively,(Pvalue 1.00). The CDE in relation to nuclear grading: nuclear grade III 26.11±11 and 24.86±4.39 for group A and B respectively, (P value 1.00), and nuclear grading IV was 43.9±4.08 and 45.94±3.97 for Group A and B respectively, (P-value 1.00). In nuclear cataract grade III, meanpostoperative percentage endothelial cell loss at 3 months was 10.88 ±3.33 and 11.86 ±2.29 % for group A and B respectively, (P-value 0.091).In nuclear grade IV, mean postoperative percentage endothelial cell loss at 3 months was 17±2.23and 18±2.12 % for group A and B respectively, (P-value 0.091). No significant differenceswere found between both groups in the postoperative (3 months) BCVA nor the increase in the mean corneal thickness with nuclear grade III or IV. Intraoperatively6 eyesin group A had tears in the posterior capsule compared to 3 eyes in group B, this was statistically significant between groups in nuclear grade III (P value 0.027).Regarding the length of the procedure in the operative theatre, there was no recognized difference between two groups, except for cases in group A-3 and B-2, where there were complications, the whole lengh of the operation was 7 minutes more than other cases .
Conclusion:
In general our small experience with the counter prechop technique showed a high rate of complications with a difficultly in acquiring the necessary surgical skills with no beneficial outcomes. Caution for surgeons interested in adopting this technique, is adviceed.
Key Words: Phacoemulsification- Phaco Prechop- Combo Prechopper- -Counter Prechop- Akahoshi
Other data
| Title | Counter Phaco-Prechop Technique In Hard Cataract | Other Titles | أسلوب الفلق المضاد للنواه ما قبل التفتيت بالموجات فوق الصوتيه فى حالات المياه البيضاء الصلبة | Authors | Dina Abdel Monem Ali Ibrahim | Issue Date | 2008 |
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