A comparative study of the effect of stop and chop versus divide and conquer techniques in phacoemusification of phaco time and corneal endothelial count

Abstract

Introduction newlineCataract is the leading cause of curable blindness of which senile cataract in the most common type. Surgical management of cataract gives good quality of life to the elderly. Corneal endothelium which is very important for transparency of cornea gets injured during the surgery. Phacoemulsification which is the procedure done to remove the opaque lens, is Linked to the depletion of endothelial cells. Several studies have been conducted to compare the effects of different techniques of phacoemulsification on corneal endothelium. Few studies conclude that Phaco time and endothelial cell loss is lesser in Stop and Chop when compared to Divide and Conquer technique. Few studies report ambiguous results too. Hence this study compared the Phaco time and endothelial cell count in between these techniques in this tertiary care centre. newlineAim newlineTo compare the Phaco time and endothelial cell count in between the techniques of Stop and Chop and Divide and Conquer in Phacoemulsification. newlineMaterials and methods newlineAn Interventional study involving 30 eyes in Group A( Stop and Chop) and 30 in Group B(Divide and Conquer) with Nuclear sclerosis grade II and III, excluding any pre-existing corneal diseases, Glaucoma and other types of cataract was conducted during January - December 2021 in Chettinad Hospital and Research Institute. All pre-operative parameters were similar in both groups which were documented. The procedure was performed by same surgeon and the same investigator conducted the follow-up. Post-operative values of BCVA, IOP, endothelial cell count, CCT, Absolute Phaco time were recorded. Data entered in Excel and analysed with SPSS. Parametric test statistical analysis employed both paired and unpaired t tests. A P value less than 0.05 indicated statistical significance. newlineResults - newlineIn this study, the mean Absolute Phaco time in secs for Group A ( Stop and Chop) technique was 25.10±10.54 seconds while that for Group B was 44.20± 6.94 seconds with statistical significance(plt0.05) .The phaco time was shorter in Stop and Chop technique than Divide and Conquer with statistical significance. The mean cell loss and changes in endothelial parameters were higher in Divide and Conquer group in comparison with Stop and Chop (plt0.05). Diabetics are at higher risk of loss of endothelial cells when compared to the non-Diabetics. newlineConclusion newlineAbsolute Phaco time is shorter in Stop and Chop than Divide and conquer as well as the corneal endothelial damage and the changes are lesser in Stop and Chop in comparison with Divide and conquer. Hence Stop and Chop technique of phacoemulsification is recommended, as it causes less corneal morbidity. newlineKeywords Stop and Chop, Divide and Conquer, Phaco time, Corneal endothelial loss newline