Abstract
PurposeTo evaluate the use of the two-hole technique in augmenting the efficiency of surgeons-in-training when performing the phaco-chop technique. We hypothesized that drilling two holes in opposite angles to each other adjacent to the capsulorhexis would mimic a new lens equator. The phaco-tip and the chopper can be inserted into these holes at appropriate depths and may sandwich and fracture the lens more easily than conventional methods.Methods The two-hole technique described above was performed by three first-year surgeons before they performed the standard phaco-chop technique. We collected data of their first 8 cases and analyzed a total of 64 cases: 16, divide-and-conquer; 24, two-hole method; 24, phaco-chop. The main outcome measures included the cumulative dissipated energy (CDE) and case ultrasound time (UST) with different phacoemulsification techniques.Results The young practicing surgeons eventually performed the standard phaco-chop more safely after repeated practice using the two-hole method. The drilling of holes enabled deep and effortless impaling of the nucleus. Although there was no significant difference in the CDE among the techniques, there was a significant difference in the UST (P < 0.05). ConclusionThe two-hole method enabled surgeons-in-training to acquire standard phaco-chop skills more efficiently. However, further studies with higher statistical power will be needed to validate these findings. Additionally, a variation of this technique, the four-hole method, is applicable even for experienced surgeons in cases of a hardened nucleus.
Highlights
A successful nuclear fracture is a crucial step in the phacoemulsification technique
There was no significant difference in the cumulative dissipated energy (CDE) among the techniques, there was a significant difference in the ultrasound time (UST) (P \ 0.05)
Wong et al reported an average UST with phaco-chop of 72 s, which was less than the average UST with divide-and-conquer (124 s) [4]
Summary
A successful nuclear fracture is a crucial step in the phacoemulsification technique. Phaco-chop, developed by Nagahara in 1993 [2], is considered one of the most effective methods for nuclear fracturing and requires less time for ultrasound sculpting [3,4,5]. Some variants, such as the twodimensional horizontal chop or three-dimensional vertical chop, have been developed and accepted for use. The vertical chop method enables deep nuclear penetration and is effective for the management of a hardened nucleus. Many modified techniques for hard cataracts have been described wherein the central part of the nucleus is drilled (or dug) to facilitate its disassembly [6,7,8]
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