Clinical Outcomes of the Eight-Chop Technique in White Cataract: A Retrospective Case Seriese

Objectives: White cataracts present substantial technical challenges during phacoemulsification because nuclear hardness cannot be assessed preoperatively and the risk of intraoperative complications is increased. This study aimed to evaluate the surgical efficiency, safety, and postoperative outcomes of the eight-chop technique in eyes with white cataracts across different levels of intraoperative nuclear hardness. Methods: This retrospective, single-center, single-surgeon observational study included eyes with white cataracts that underwent phacoemulsification using the eight-chop technique between January 4, 2010, and March 25, 2025. White cataract was defined as a completely white and opaque lens with absent red reflex on slit-lamp examination. Nuclear hardness was classified intraoperatively according to the Emery classification. Intraoperative parameters, corneal endothelial cell density (CECD), corneal endothelial morphology, intraocular pressure (IOP), and best-corrected visual acuity (BCVA) were evaluated preoperatively and postoperatively. Outcomes were compared among nuclear hardness groups. Results: Among 12,642 cataract surgeries performed during the study period, 126 eyes were diagnosed with white cataracts. After exclusions, 105 eyes were included in the final analysis. Operative time, phacoemulsification time, and cumulative dissipated energy increased significantly with nuclear hardness (all p < 0.01), whereas aspiration time and irrigation fluid volume did not differ significantly among groups. CECD loss at 7 and 19 weeks postoperatively was minimal, with no significant differences among hardness groups. Transient changes in corneal endothelial morphology were observed postoperatively but resolved by 19 weeks. Postoperative IOP decreased significantly in eyes with higher nuclear hardness. BCVA improved markedly in all groups, and differences observed in the early postoperative period disappeared over time. Posterior capsule rupture occurred in 2 of 105 eyes, and no cases of dropped nucleus were observed. Conclusions: The eight-chop technique enables safe and efficient phacoemulsification in eyes with white cataracts across a wide range of nuclear hardness. This technique minimizes ultrasound energy and corneal endothelial damage while providing favorable visual outcomes and acceptable complication rates, even in advanced cases.