Bore and chop a new technique to optimize endothelial cell loss in hard grade IV+ cataracts and achieving clear corneas on first postoperative day
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First Author: R.Odeyar INDIA
Co Author(s): S. Shaha
To evaluate a new technique of Bore and Chop in very hard grade IV+ cataracts in minimising endothelial loss and achieving clear corneas on 1st post operative day
110 patients were operated by single surgeon using same phacoemulsification machine and microscope from October 2019 to February 2020 with bore and chop technique. In all patients blunt tipped chopper with inner cutting edge and flared phaco tip was used.
Inclusion criteria- Cataracts with grade IV+ nucleus Exclusion criteria- Cataracts with corneal opacity After central curvilinear capsulorexis central hole was created in hard core of nucleus with bevel down using flared phaco tip. The bevel was turned up, nucleus engaged and chopped in the bag with blunt tipped chopper with inner cutting edge and emulsified in the bag or pupilary plane. In 60% cases topical anesthesia was used and 40% cases peri bulbar anaesthesia was used Pre and post operative specular microscope count was compared . First postoperative day photographs were taken in all patents to access corneal clarity.
Average endothelial cell loss in Bore and chop technique was found to be between 10 to 18% and in 4 quadrant technique was 15 to 35% . 107 patents had clear cornea on day one 2 patients had striate keratitis days clearing within 3 and one patient PCR managed with anterior vitrectomy and iris claw IOL.Endothelial loss was 25%, 28% and 32% respectively in these 3 patients.
Less energy was required to divide the nucleus as the phaco tip was embedded in nucleus while dividing and emulsifying it resulting in clear corneas on day one. 107 patients achieving clear cornea on day one with average endothelial cell loss of 10 to 18% in group. With use of blunt tipped chopper incidence of posterior capsular rupture is also less From results we can conclude that Bore and Chop is better technique to reduce endothelial cell loss and maintains clear corneas in more than 97% patients on day one.