Phacoemulsification in the anterior chamber

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Purpose: To evaluate anterior chamber phacoemulsification as an alternative to an endocapsular procedure. Setting: Instituto Oftalmológico de Alicante, Alicante, Spain. Methods: In this prospective randomized masked clinical trial, 60 eyes of 30 patients had cataract extraction by phacoemulsification. A conventional stop-and-chop technique was used in 30 eyes; the other 30 had surgery by the phaco-out technique in which the nucleus was prolapsed into the anterior chamber using extensive hydrodissection. Copious sodium hyaluronate 3.0%-chondroitin sulfate 4.0% (Viscoat®) and hydroxypropyl methylcellulose were used to protect the cornea and iris. The phaco time and power, postoperative inflammation, corneal edema (clinically and by pachymetry), and endothelial cell count between groups preoperatively and postoperatively were compared. All patients completed a 3-month follow-up. Postoperative examinations were at 3 days, 2 weeks, and 1 and 3 months. Results: The mean nuclear hardness was 2.67 ± 0.61 (SD) in the stop-and-chop group and 2.65 ± 0.71 in the phaco-out group. The power-to-time ratio was 18.47 and 18.80, respectively. The mean endothelial cell loss was 11.18% ± 4.24% in the stop-and-chop group and 11.20% ± 5.60% in the phaco-out group. There were no significant differences between groups in any parameter ( P > .05, independent-sample t test). Conclusion: Phacoemulsification in the anterior chamber was as safe as endocapsular phacoemulsification using a stop-and-chop technique. This technique is fast and easier to learn than endocapsular phacoemulsification.