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Michael A. Klufas, Brandon Rodriguez, Christopher E. Starr; "Pop & Prechop": Outcomes And Complication Rates Of A Novel Safe Supracapsular Phacoemulsification Technique For Beginning Cataract Surgeons. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5703.
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To determine the outcomes of a novel supracapsular phacoemulsification technique designed for beginning surgeons.
Prospective data collection on consecutive "Pop & Prechop" cataract extraction (CE) surgeries performed by a single attending surgeon with trainees. Data was collected through review of patient charts and phacoemulsification machine case data. Corneal edema (graded 0-4+; 0=no edema, 0.5=trace (peripheral), 1+, 2+, 3+, 4+ central Descemet’s folds) was recorded preoperatively and at postoperative day 1, week 1 and month 1. Confocal microscopy was performed prior to surgery and 1 month after surgery to evaluate endothelial cell (EC) count.
Of 83 procedures performed, 20% were preoperatively classified as complex (pseudoexfoliation syndrome, intraoperative floppy iris syndrome, zonular weakness, pupillary miosis). All cases were performed by trainees (73% fellows, 27% residents). No intra-operative complications (vitreous loss, capsular violation, unplanned vitrectomy, iris or corneal trauma) occurred which is significantly lower than published rates of 6-14.7% for trainee surgery. Fuchs’endothelial dystrophy affected 8.4% of eyes. Corneal edema scores at postoperative day 1, week 1 and month 1 were 0.79, 0.16 and 0.00, respectively. Mean EC loss was 6.95% (N=19) which compares favorably to reported rates for intracapsular phacoemulsification CE of 3.2-23.2%. No statistically significant difference in EC loss was seen when comparing eyes with axial length <23 mm vs. ≥23 mm (10.7% vs. 5.3%, p=0.15), anterior chamber depth <3 mm vs. ≥3 mm (6.9% vs. 7.0%, p=0.46) or treated with total ultrasound time <1 min vs. ≥1 min (5.6% vs. 8.4%, p=0.34). Operative data for this series showed a mean total ultrasound time of 1 min 14 sec, mean phacoemulsification time of 0.9 sec, and average cumulative dissipated energy (CDE) of 11.13. Compared to intracapsular phacoemulsification ("Divide & Conquer"), "Pop & Prechop" utilizes an average of 75% less energy as measured by CDE (51.16 vs. 11.13, p<0.0001).
"Pop & Prechop" is an effective and safe alternative to intracapsular CE. The technique, by performing the prechop manually in the anterior chamber, combines the advantages of supracapsular surgery (protection of the posterior capsule) and minimizes its disadvantages (EC loss). There were no intra-operative complications and all corneas were clear of edema by 1 month in this large series of trainee-performed surgery.
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