Scoop and chop - A modified phaco-chop technique for pseudoexfoliation and cataract

PURPOSE: The purpose is to evaluate the results of the modified direct phaco-chop technique of cataract surgery in eyes with pseudoexfoliation. METHODS: All patients with pseudoexfoliation and visually significant cataract with normal intraocular pressure (IOP) and optic nerve that underwent cataract surgery by the same surgeon using Infiniti(®), OZil(®) Torsional handpiece (Alcon Labs), were included for this retrospective hospital-based study. Direct vertical or horizontal chop technique was used in all cases with parameters set as required for quadrant removal with high vacuum after the initial cleanup of cortex under the capsulorhexis. To allow better visualization of the hardness of the nucleus core, the sides of the lens were scooped out a central well with vacuum with maximum chopping done centrally within the rhexis as the first step to enable better assessment of the depth of burying the chopper for direct chop. Intraoperative details recorded and analyzed included ultrasound time and cumulative dissipated energy. The mean visual acuity and IOP before and after surgery were recorded at 1 day, 1 week, and 1 month. Complications during or after surgery were noted. RESULTS: A total of 138 patients with a mean age of 62 ± 6.7 years underwent phachop technique of phacoemulsification for nuclear cataract grades of nuclear sclerosis 2–4 with significant improvement in visual acuity from baseline (0.26) to 3 months (0.82), P < 0.001. The mean ultrasound torsional amplitude and cumulative dissipated energy (CDE) were greater for brown cataract of grading >3, P = 0.02. A total of 8 patients had intraoperative zonular dialysis in 1 quadrant (none in >1 quadrant), which was not associated with intraoperative vitreous prolapse in 6 eyes. CONCLUSIONS: Direct modified phaco-chop technique may be a safe technique in pseudoexfoliation due to minimal zonular stress with successful outcomes and reduced complications.