180-Degree Nuclear Flip: A Safety and Efficacy Assessment of a Phacoemulsification Technique for Cataract Nuclei of Grade III and Below

INTRODUCTION: This prospective randomized controlled trial aims to evaluate the effectiveness and safety of a 180° nuclear flip technique in phacoemulsification cataract surgery, comparing it with the traditional endocapsular approach for cataracts of Emery-Little grade III and below. METHODS: A total of 142 patients were randomly assigned to either the 180° nuclear flip group (n = 71) or the conventional endocapsular phacoemulsification group (n = 71). The primary outcomes measured were total phacoemulsification time (TPT) and effective phacoemulsification time (EPT). Secondary outcomes were the incidence of postoperative corneal endothelial cell loss (ECL) at 7 and 28 days, as well as intraoperative complications including posterior capsule rupture (PCR). RESULTS: The mean TPT was substantially shorter in the flip group (43.75 ± 17.16 s) compared to the conventional group (58.45 ± 22.27 s) (P < 0.0001). Similarly, the mean EPT was also significantly reduced in the flip group (11.08 ± 5.25 s vs. 14.87 ± 8.54 s, P = 0.0046). There were no PCR cases in the flip group, whereas there was one case (1.4%) in the traditional group. At 28 days postoperatively, the mean ECL rate of the flip group (3.7%) was lower than that of the conventional group (4.9%), although this difference did not reach statistical significance. CONCLUSION: The 180° nuclear flip technique is a safe, efficient, and effective method for managing cataracts of grade III hardness and below. It may help reduce the risk of complications, improves intraoperative stability by creating a more spacious operating field, and significantly reduces phacoemulsification time. Video available for this article. TRIAL REGISTRATION: chictr.org.cn identifier, ChiCTR2500105241.