Michele Coppola1, Alessandro Marchese2, Alessandro Rabiolo1,2, Maria Vittoria Cicinelli1,2, Karl Anders Knutsson3,4. 1. Ophthalmology Unit, Desio Hospital, Desio, Monza-Brianza, Italy. 2. Department of Ophthalmology, San Raffaele Scientific Institute, Milan, Italy. 3. Ophthalmology Unit, Desio Hospital, Desio, Monza-Brianza, Italy. ka.knutsson@gmail.com. 4. Cornea and Ocular Surface Unit, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy. ka.knutsson@gmail.com.
Abstract
PURPOSE: To compare two common phacoemulsification techniques in the learning curve phase, and their effect on ultrasound energy dissipation. METHODS:One hundred and ten consecutive patients scheduled for cataract surgery with the same surgeon in training were prospectively enrolled. Study was divided in two parts. In the first one, 60 patients were stratified for cataract grade [nuclear opalescence (NO) grade 2-4] and divided in two groups receivingsurgery with the divide-and-conquer technique (Group-1) and with the stop-and-chop technique (Group-2). In the second part, 50 patients were stratified according to cataract grade (NO2-6), and the surgeon had to choose one of the two techniques according to personal preference. The primary outcome was the cumulative dissipated energy (CDE). RESULTS: Significant differences of CDE were observed between the NO3 and NO4 cataracts in Group-1. In Group-2, this difference was not significant, suggesting that with more advanced cataracts, the stop-and-chop technique allows less ultrasound use. In the second part of the study, the stop and chop was most frequently used for more advanced cataracts. When considering harder cataracts (NO5-NO6), patients receiving surgery with the divide-and-conquer technique had higher CDE values compared to stop and chop. CONCLUSIONS: Both divide-and-conquer and stop-and-chop techniques are efficient in the learning curve. Stop and chop dissipates less energy in harder nuclei. Once surgeons reach sufficient experience with both techniques, they should switch to a stop-and-chop technique, allowing lower levels of ultrasound energy.
RCT Entities:
PURPOSE: To compare two common phacoemulsification techniques in the learning curve phase, and their effect on ultrasound energy dissipation. METHODS: One hundred and ten consecutive patients scheduled for cataract surgery with the same surgeon in training were prospectively enrolled. Study was divided in two parts. In the first one, 60 patients were stratified for cataract grade [nuclear opalescence (NO) grade 2-4] and divided in two groups receiving surgery with the divide-and-conquer technique (Group-1) and with the stop-and-chop technique (Group-2). In the second part, 50 patients were stratified according to cataract grade (NO2-6), and the surgeon had to choose one of the two techniques according to personal preference. The primary outcome was the cumulative dissipated energy (CDE). RESULTS: Significant differences of CDE were observed between the NO3 and NO4 cataracts in Group-1. In Group-2, this difference was not significant, suggesting that with more advanced cataracts, the stop-and-chop technique allows less ultrasound use. In the second part of the study, the stop and chop was most frequently used for more advanced cataracts. When considering harder cataracts (NO5-NO6), patients receiving surgery with the divide-and-conquer technique had higher CDE values compared to stop and chop. CONCLUSIONS: Both divide-and-conquer and stop-and-chop techniques are efficient in the learning curve. Stop and chop dissipates less energy in harder nuclei. Once surgeons reach sufficient experience with both techniques, they should switch to a stop-and-chop technique, allowing lower levels of ultrasound energy.
Entities:
Keywords:
Cataract surgery; Divide and conquer; Phacoemulsification; Stop and chop; Surgical training, cumulative dissipated energy
Authors: Jung Hyun Park; Sang Mok Lee; Ji-Won Kwon; Mee Kum Kim; Joon Young Hyon; Won Ryang Wee; Jin Hak Lee; Young Keun Han Journal: Ophthalmic Surg Lasers Imaging Date: 2010 Mar-Apr
Authors: Abhishek R Payal; Luis A Gonzalez-Gonzalez; Xi Chen; Tulay Cakiner-Egilmez; Amy Chomsky; Elizabeth Baze; David Vollman; Mary G Lawrence; Mary K Daly Journal: J Cataract Refract Surg Date: 2016-03 Impact factor: 3.351