Comparison of corneal endothelial cell loss following cataract phacoemulsification using the divide-and-conquer technique versus the direct chop technique

Abstract Background: The most prevalent methods of nucleotomy for phacoemulsification of cataracts are divide-and-conquer and phaco chop. The current research aimed to assess and compare the endothelial cell loss (ECL) and distant visual acuity (DVA) following topical phacoemulsification surgery employing either the divide-and-conquer or direct chop techniques for nucleotomy. Materials and Methods: We conducted a prospective observational study at a single tertiary care hospital by including consenting adults aged more than 50 years with cataracts of nuclear sclerotic (NS) grade II or higher. Study participants were segregated into either Group A who underwent cataract phacoemulsification using the divide-and-conquer technique or Group B where the direct chop method was used. Follow-up examinations were performed on weeks 1, 4, and 12 where corneal endothelial cell density was measured using a specular microscope and DVA was examined. Results: Sixty patients were part of the research, with 30 patients in each group. The ECL was significantly higher for patients undergoing nucleotomy by the divide-and-conquer method (476 cells/mm 2 , 22.76%) compared to those undergoing the direct chop method (304 cells/mm 2 , 14.92%). The DVA improved for both groups of patients, but there was no significant difference between them ( P = 0.695). Conclusion: Patients who have senile cataracts of NS II grade or higher experience less corneal endothelial damage when the direct chop technique is used, as compared to the divide-and-conquer technique.