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Debora Garcia-Zalisnak, Fredric Gross; Pop and Chop vs. Divide and Conquer: Zero and Low Energy Nucleus Disassembly Technique for Teaching Beginner Surgeons. Invest. Ophthalmol. Vis. Sci. 2016;57(12):941.
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© ARVO (1962-2015); The Authors (2016-present)
In most ophthalmology residency programs, the Divide and Conquer (D&C) technique is taught as the initial method of nuclear disassembly because of its safety and reproducibility. Pop and Chop (P&C) is a less known technique in which the nucleus is prolapsed or tilted into the anterior chamber, manually chopped, and then removed by phacoemulsification. The purpose of this study was to compare surgical case times, changes in pachymetry, amount of energy, and complications between these two techniques.
This was a prospective, randomized, single center, non-blinded study. All the patients undergoing non-complex cataract surgery at the Hampton Veterans Affairs Medical Center between July and October 2015 were included. The resident was the primary surgeon and was assisted by the attending using the Alcon Centurion system. The cases were randomly assigned to the P&C or the D&C technique. Patients with cataracts complicated by trauma, pseudoexfoliation, or prior ocular surgery were excluded from the study.
Demographics characteristics data for the two groups were compared in a univariate analysis using Student's t-test for continuous variables and Chi-Square test for categorical variables. The study sample consisted of n=81 subjects of whom 45 (55.56%) were in the D&C group and 46 (44.44%) were in the P&C. There was no statistical difference between the two methods in terms of demographics variables. The results of the Wilcoxon analysis indicate that the D&C method used more total fluid (p< 0.001) and had a greater CDE(p< 0.001). The P&C method had a greater change in pachymetry from baseline to POD-1(p=0.0018). There was no statistically significant change in baseline to POM 1 pachymetry or in the complication rate between both groups. Of note, there were 3 cataracts that were removed using 0 CDE and 7 more using <1 CDE. All of these cataracts were disassembled using the P&C technique.
P&C is a safe and efficient method of nucleus disassembly that can be taught to beginner surgeons as easily as D&C. When comparing with D&C, P&C proved to be faster and required less energy. P&C leads to more corneal edema acutely after surgery but this edema was resolved in both groups at the end of the first month. In otherwise healthy eyes with non-complex cataracts, P&C proves to be a worthy tool to add to a beginner surgeon's technique arsenal.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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