Cumulative Dissipated Energy (CDE) in Three Phaco-Fragmentation Techniques for Dense Cataract Removal

Erika Fernández-Muñoz,1,&ast; Yolanda Chávez-Romero,1,&ast; Ricardo Rivero-Gómez,1,&ast; Rebeca Aridjis,2,&ast; Roberto Gonzalez-Salinas1,&ast; 1Anterior Segment Surgery Department. Asociación para Evitar la Ceguera en México I.A.P., Mexico City, Mexico; 2LaSalle School of Medicine, Mexico City, Mexico&ast;These authors contributed equally to this workCorrespondence: Erika Fernández-Muñoz, Anterior Segment Surgery Department, Asociación para Evitar la Ceguera en México I.A.P, Vicente García Torres 46, Barrio San Lucas, Coyoacán, PO. 04030, Mexico City, Mexico, Tel +52 55 10841400, Ext 1144, Email efernandez2108@gmail.comPurpose: To determine the energy expenditure in phacoemulsification surgery expressed as cumulative dissipated energy (CDE) among the divide and conquer, ultrachopper-assisted divide and conquer, and phaco-chop techniques for dense cataract removal.Patients and Methods: The clinical data were obtained from the medical charts of dense cataracts patients undergoing routine phacoemulsification employing any of three phaco-fragmentation techniques, including divide and conquer using the Kelman 0.9 mm tip, the ultrachopper tip, and the phaco-chop technique using the Kelman 0.9 mm tip. Cumulated dissipated energy (CDE), longitudinal ultrasound time (UST), and endothelial cell loss were compared among groups at the one-month postoperative.Results: Surgeries from 90 eyes were analyzed, among whom the conventional divide-and-conquer technique group included 30 patients, 32 in the ultrachopper group, and 28 in the phaco-chop technique group. The average CDE in the conventional divide and conquer group was 44.52 ± 23.00, the ultrachopper technique was 43.27 ± 23.18, and 20.11 ± 11.06 in the phaco-chop group. Phaco-fragmentation chop demonstrated significantly lower CDE than the other techniques (p= < 0.0001). The phaco-chop technique showed statistically significantly lower CDE when compared to the other two groups (p=< 0.0001) with 93.96 ± 39.71 seconds. There were no statistically significant differences in postoperative endothelial cell density between groups (p=0.4916).Conclusion: The use of the phaco-chop technique in hard cataract phacoemulsification represents a lower energy expenditure than divide and conquer and ultrachopper techniques; nevertheless, no differences regarding endothelial density loss were evidenced.Keywords: dense cataracts, ultrachopper, phaco-chop, stop-and-chop technique, divide-and-conquer technique, cumulative dissipated energy