“Chopper Shield” Technique to Protect Corneal Endothelium During Phacoemulsification Surgery for Rock Hard Cataracts

Abstract

Purpose: To describe an innovative technique of using a chopper as a shield for preventing mechanical corneal endothelial trauma that can occur during the phacoemulsification of brunescent cataracts. Methods: This prospective study included patients with hard cataracts (grade nuclear opalescence 4 and above on LOCS III) who underwent phacoemulsification surgery. The chopper shield technique was performed in 48 eyes of 44 patients. The technique entailed placing the chopper horizontally as a shield anterior to the emulsifying nuclear fragment between the phaco tip and corneal endothelium to prevent nucleus fragments from coming into contact with the corneal endothelium. Outcome measures included cumulative dissipated energy (CDE), corneal edema (day one), CCT (assessed at one day, one week, and one month), and endothelial cell density assessed at three months. Results: Of the 48 eyes included in the study, 23 were males and 25 were females (mean age: 70.02±5.98years). Preoperatively, mean central corneal thickness (CCT) was 529.62 ±21.70 microns, and endothelial cell counts were 2258.76±182.22 cells per mm2. Postoperatively on day one, CCT increased to 563.93±24.53 microns, a 6.47% increase from preoperative central corneal thickness. CCT became 534.83±22.64 microns on postoperative day seven, a 0.98% increase from preoperative CCT. Endothelial cell loss was 6.77% at three months from the day of surgery. Conclusion: The chopper shield technique offers continuous protection to the corneal endothelium by minimizing endothelial cell loss during phacoemulsification of dense nuclear cataracts.