Posterior Capsule Rupture and Dropped Nucleus with the Eight-Chop Technique: A Video-Verified Single-Surgeon Cohort of 3749 Eyes

Purpose: Posterior capsule rupture (PCR) and dropped nucleus are serious intraoperative complications of cataract surgery. This study aimed to describe the observed incidence, timing, and presumed mechanisms of these complications in a video-verified consecutive cohort undergoing phacoemulsification with the Eight-Chop Technique as the primary nuclear disassembly method, rather than to establish comparative safety or superiority between surgical techniques. Methods: This retrospective observational cohort study included 3749 consecutive eyes of 2039 patients undergoing cataract surgery by a single surgeon between 2021 and 2026. The Eight-Chop Technique was the primary nuclear disassembly method; Lance-Chop was selectively used according to clinical criteria, including hard nuclei or suspected zonular weakness. All surgical videos were reviewed to confirm complications, identify the operative phase, and classify events as procedure-related or associated with presumed capsular or zonular weakness. Major intraoperative complications were defined as isolated PCR or dropped nucleus. Results: Major intraoperative complications occurred in 17 unique eyes (0.45%), comprising 14 eyes with isolated PCR and three eyes with dropped nucleus. Overall, PCR occurred in 16 eyes (0.43%) and dropped nucleus in three eyes (0.08%); two eyes experienced both events and were counted once in the composite outcome, within the dropped-nucleus group. Complications occurred in 10 of 3381 eyes (0.30%) treated with Eight-Chop and 7 of 368 eyes (1.90%) treated with Lance-Chop. The unadjusted odds ratio was 6.53 (95% confidence interval, 2.10– 19.13; p < 0.001), but the association was attenuated after adjustment for nuclear grade (odds ratio, 2.75; 95% confidence interval, 0.48– 14.32; p = 0.253). Ten events occurred in eyes with presumed capsular or zonular weakness, whereas seven had identifiable procedural components. All 14 evaluable eyes achieved a final best-corrected visual acuity of 0.10 logarithm of the minimum angle of resolution (logMAR) or better, including 8 of 11 isolated-PCR eyes and 1 of 3 dropped-nucleus eyes with 0.00 logMAR or better. No eye underwent a separate subsequent ocular operation during follow-up. Conclusion: In this large, video-verified single-surgeon cohort, the observed rates of PCR and dropped nucleus were low. Video review identified potentially modifiable procedural circumstances and events associated with presumed capsular or zonular weakness. Comparisons between Eight-Chop and Lance-Chop should be interpreted cautiously because of selective use of Lance-Chop in more complex eyes. Keywords: cataract surgery, eight-chop technique, posterior capsule rupture, dropped nucleus, phacoemulsification