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Corneal endothelial changes after divide and conquer versus chip and flip phacoemulsification
P Kosrirukvongs1, S G Slade, R G Berkeley
1Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkoknoi, Bangkok, Thailand.
Purpose:
To evaluate changes in central corneal endothelial cells and corneal thickness after divide and conquer phacoemulsification and chip and flip phacoemulsification.
Setting:
Houston Eye Clinic, Houston, Texas, USA.
Methods:
Forty-four eyes were randomly assigned to one of two groups to have divide and conquer (D/C Group) or chip and flip (C/F Group) phacoemulsification with implantation of a posterior chamber, foldable, silicone intraocular lens performed by one surgeon. Of these, 41 eyes of 37 patients (22 D/C Group, 19 C/F Group) met the inclusion criteria. All surgeries were uneventful. A complete eye examination including specular microscopy and pachymetry was performed preoperatively and 1 week and 1 and 3 months postoperatively.
Results:
There were no significant between-group differences in any of the following means: sex; age; time at 70% phaco power; total phacoemulsification time. No correlation was found between ultrasound time and increased corneal thickness except for a significant increase in percentage of hexagonal cells in the C/F Group at 1 month. The only statistically significant between-group differences were greater endothelial cell loss in the C/F Group at 1 month and the percentage change in hexagonal cells at 1 week (1.1% increase, D/C Group; 10.7% decrease, C/F Group).
Conclusion:
The divide and conquer technique led to less endothelial loss and hexagonal cell change than the chip and flip technique, although at 3 months the differences were not significant.