Minimizing Endothelial Cell Loss in Hard Nucleus Cataract Surgery: Efficacy of the Eight-Chop Technique

Purpose: To estimate the efficacy of the eight-chop technique in phacoemulsification surgeries for patients with hard nucleus cataracts by investigating corneal endothelial cell density (CECD) reduction post-phacoemulsification and intraoperative parameters.Setting: Sato Eye Clinic, Chiba-ken, Japan.Design: Prospective case series.Methods: Patients were categorized into three groups (Grade IV, IV plus, and V) according to the hardness of their lens nuclei. Surgeries were performed using the eight-chop technique. Key intraoperative metrics (operative time, phaco time, aspiration time, cumulative dissipated energy [CDE], and fluid volume used) were measured. Pre- and postoperative assessments included corrected distance visual acuity, intraocular pressure (IOP), endothelial cell size variation, hexagonal cell percentage, central corneal thickness, and CECD.Results: Overall, 89 eyes from 67 patients with cataracts were evaluated. The mean operative time, phaco time, aspiration time, CDE, and fluid volume used across Grades IV, IV plus, and V were 10.5 min, 38.9 s, 135.6 s, 19.2, and 53.0 mL, respectively. At 19 weeks postoperatively, the CECD decreased by 0.2%, 6.8%, and 9.6% for Grades IV, IV plus, and V, respectively, with an average decrease of 3.7%. Significant reductions in postoperative IOP were observed across all groups compared with preoperative IOP (p < .01). Loss of CECD significantly correlated with phaco time, CDE, and fluid volume (p = .027, p < .01, and .034, respectively).Conclusions: The eight-chop technique in phacoemulsification for hard nucleus cataracts resulted in minimal CECD loss. It may provide an effective surgical solution for patients with hard nucleus cataracts.