Clinical outcomes of the Eight-chop technique in white cataract: a retrospective case series

Background White cataracts pose substantial technical challenges during phacoemulsification because preoperative assessment of nuclear hardness is impossible and the risk of intraoperative complications is increased. The Eight-chop technique was developed to mechanically fragment the lens nucleus into eight pieces prior to ultrasound emulsification, potentially reducing intraocular stress. This study aimed to evaluate the safety and efficacy of the Eight-chop technique in eyes with white cataract and to compare surgical outcomes according to intraoperatively assessed nuclear hardness. Methods This retrospective, single-center, single-surgeon observational study included eyes with white cataract that underwent phacoemulsification using the Eight-chop technique between January 2010 and March 2025. White cataract was defined as complete lens opacification with an absent red reflex. Nuclear hardness was classified intraoperatively using the Emery classification. Intraoperative parameters included operative time, phacoemulsification time, cumulative dissipated energy (CDE), aspiration time, and irrigation fluid volume. Postoperative outcomes included corneal endothelial cell density (CECD), endothelial morphology, intraocular pressure (IOP), and best-corrected visual acuity (BCVA), evaluated preoperatively and at 7 and 19 weeks postoperatively. Outcomes were compared among nuclear hardness groups. Results Of 12,642 cataract surgeries performed during the study period, 105 eyes with white cataract were included in the final analysis. Operative time, phacoemulsification time, and CDE increased significantly with increasing nuclear hardness (all p < 0.01), whereas aspiration time and irrigation fluid volume did not differ significantly among groups. Mean CECD loss at 7 and 19 weeks postoperatively was minimal, with no significant differences among nuclear hardness groups. Transient postoperative changes in corneal endothelial morphology were observed but resolved by 19 weeks. Postoperative IOP decreased significantly in eyes with higher nuclear hardness. BCVA improved markedly in all groups, and early postoperative differences according to nuclear hardness 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 cataract across a wide range of nuclear hardness. The technique minimizes ultrasound energy delivery and preserves corneal endothelial integrity while providing favorable visual outcomes and acceptable complication rates, even in advanced cases.