Phacofracture versus phacoemulsification in eyes with age-related cataract

To compare manual phacofracture and phacoemulsification techniques.

Dr. Rajendra Prasad Centre for Ophthalmic Sciences, New Delhi, India.

This prospective, randomized study comprised 60 cases of age-related cataract randomly divided into 2 groups: 30 eyes had phacoemulsification and 30, manual phacofracture using a trisection technique. Postoperative evaluation was at 1 day, 1 and 6 weeks, and 3 months. The parameters evaluated were amounts of viscoelastic material and irrigating fluid used, the time required to manage the nucleus, postoperative best corrected visual acuity, endothelial cell loss, and complications.

Mean viscoelastic material used intraoperatively (3.69 mL +/- 0.81 [SD] versus 1.76 +/- 0.54 mL) and the time required to manage the nucleus (7.78 +/- 2.07 minutes versus 2.53 +/- 1.18 minutes) were significantly greater in the phacofracture than in the phacoemulsification group, respectively. Best corrected visual acuity was significantly better in the phacoemulsification group on the first postoperative day; 64% had a visual acuity of 6/9 or better versus 37% in the phacofracture group. Endothelial cell loss at 3 months was 17.66 +/- 3.65% in the phacofracture group and 12.03 +/- 3.06% in the phacoemulsification group and central corneal edema persisting for more than 1 week, 7 and 0 cases, respectively. The differences between groups were statistically significant.

More experience in and further modification of the manual phacofracture technique are required before it can be recommended as a safe alternative to phacoemulsification.