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The Eight‑Chop Technique in Cataract Surgery: A Conceptual and Narrative Review of a Segmentation‑First Strategy.

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Postoperative Flare and Corneal Endothelial Cell Loss After Eight-Chop Technique Phacoemulsification: A Prospective Observational Study.

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Does Further Lowering Intraoperative Intraocular Pressure Reduce Surgical Invasiveness in Active-Fluidics Eight-Chop

Tsuyoshi Sato1

  • 1Department of Ophthalmology, Sato Eye Clinic, Nemoto 3-3, Matsudo-shi 271-0077, Chiba-ken, Japan.

Journal of Clinical Medicine
|January 10, 2026
PubMed
Summary

Lowering intraocular pressure (IOP) during phacoemulsification did not reduce surgical invasiveness or improve outcomes. The Eight-Chop technique with active fluidics ensured chamber stability, making further IOP reduction unnecessary for enhanced safety or efficiency.

Keywords:
aqueous flarecataract surgerycorneal endothelial celleight-chop techniquelow intraocular pressure settingphacoemulsification

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Area of Science:

  • Ophthalmology
  • Surgical Technology
  • Biomedical Engineering

Background:

  • Active fluidics in phacoemulsification maintains anterior chamber stability at lower intraocular pressure (IOP).
  • The impact of reduced IOP alone, without additional stabilizing devices, on surgical invasiveness during Eight-Chop phacoemulsification is not well understood.

Purpose of the Study:

  • To investigate whether reducing intraoperative IOP alone can decrease surgical invasiveness during Eight-Chop phacoemulsification.
  • To evaluate the effect of lower intraoperative IOP on postoperative outcomes, including inflammation and endothelial cell preservation.

Main Methods:

  • A prospective fellow-eye comparative study involving 56 patients (112 eyes) undergoing Eight-Chop phacoemulsification.
  • One eye was assigned a standard-IOP setting (55 mmHg) and the fellow eye a reduced-IOP setting (28 mmHg) using the Centurion Vision System with active fluidics.
  • Intraoperative parameters and postoperative outcomes (aqueous flare, corneal endothelial cell density, corneal morphology) were recorded and compared.

Main Results:

  • Lowering intraoperative IOP did not reduce surgical invasiveness; phaco time and aspiration time were significantly longer in the low-IOP group.
  • No significant differences were observed in operative time, cumulative dissipated energy (CDE), or irrigation volume between the groups.
  • Postoperative outcomes, including aqueous flare, corneal endothelial cell density loss, corneal morphology, and IOP, were comparable between the standard-IOP and low-IOP settings.

Conclusions:

  • Reducing intraoperative IOP from conventional to near-physiologic levels under active fluidics control does not decrease surgical invasiveness in Eight-Chop phacoemulsification.
  • No additional short-term clinical advantages were found regarding endothelial cell preservation, postoperative inflammation, or surgical performance.
  • When chamber stability is assured by a low-invasive fragmentation technique, further IOP reduction alone does not offer measurable benefits.