Comparison of Pacman cutting technique and trisection cutting technique for hydrophobic acrylic intraocular lens removal

The objective of this retrospective cohort study is to compare the Pacman cutting technique with the trisection cutting technique for hydrophobic acrylic intraocular lens extraction. A total of 29 eyes of 29 patients requiring IOL removal were selected and enrolled in this study. The patients in group 1 (13 cases) underwent the conventional trisection cut technique from May 2022 to Dec. 2022. The patients in group 2 (16 cases) underwent the modified partial IOL cutting technique (Pacman cutting technique) from Jan. 2023 to June 2023. Corneal endothelial cells (CECs) count, slit-lamp examination, and intraocular pressure (IOP) measurement were conducted at all preoperative and postoperative visits. Surgical time, intraoperative and postoperative complications were recorded. The mean surgical time was 3.48 ± 1.54 minutes (range: 2 to 7 minutes) for the trisection cut technique group and 2.52 ± 1.18 minutes (range: 2 to 5 minutes) for the Pacman cut technique group. There was a statistically significant difference between the two groups in terms of surgical duration (P < .05). There was no difference in the mean preoperative CEC counts (group 1: 1924 ± 462, group 2: 1876 ± 516, P > 0.05). However, three months after the operation, the count of CECs decreased by 213 ± 72 (11%) in group 1 and 142 ± 57 (8%) in group 2. The decrease in CECs in group 1 was greater than that in group 2, and the difference was statistically significant (P < .05). There were no serious complications affecting vision in either group during the follow-up period. This study showed that the Pacman cutting technique is more effective and safer than the trisection cutting technique for hydrophobic acrylic IOL removal.