Purpose:
To assess and compare the outcomes of resident-performed phacoemulsification using two distinct surgical techniques (divide and conquer, pop and chop).
Methods:
Retrospective chart review of phacoemulsification cases performed by three resident surgeons at the New York Presbyterian Hospital, New York, New York from July 1, 2010 to June 30, 2011. Supervision was provided by two attending surgeons. Patient’s age, pre-existing ocular conditions and surgical technique (divide and conquer versus pop and chop) were evaluated. Outcomes analyzed included intraoperative complications, uncorrected visual acuity (UCVA) and best-spectacle corrected visual acuity (BSCVA).
Results:
Of the 92 cases analyzed, 43 (46.7%) were done using a divide and conquer technique and 49 (53.2%) were done using a pop and chop technique. There were no significant differences in patient demographics. There were no major complications (endophthalmitis, TASS, suprachoroidal hemorrhage, retinal detachment, persistent corneal edema or intraocular lens dislocation) in either group. Posterior capsular tears occurred in 7 cases (7.6%) overall, with 3 (6.9%) in the divide and conquer group and 4 (8.1%) in the pop and chop group. Vitreous loss occurred in 6 cases (6.5%) overall, with 3 (6.97%) in the divide and conquer group and 3 (6.1%) in the pop and chop group. Two patients were excluded from analysis of final visual acuity secondary to lack of follow-up data. Overall, 73/90 (81.1%) achieved a final best spectacle-corrected visual acuity (BSCVA) of 20/40 or better, with 35/42 (83.3%) in the divide and conquer group and 38/48 (79.2%) in the pop and chop group. Final BSCVA improved to 73/74 (98.6%) if patients with pre-existing ocular conditions (retinopathy, keratopathy or amblyopia) limiting BSCVA were excluded, with 35/35 (100%) in the divide and conquer group and 38/39 (97.44%) in the pop and chop group. Univariate analysis showed no statistically significant differences between the two surgical techniques (p>0.05)
Conclusions:
Both phacoemulsification methods (divide and conquer and pop and chop) are appropriate techniques for resident surgeons. There were no significant differences in outcomes between the two techniques and complication rates and visual outcomes were similar to previous published series.
Keywords: cataract • training/teaching cataract surgery