Rotation phaco techniques most effective for soft to medium nuclear density

Ophthalmic Surg Lasers Imaging. 2009;40(3):222-231.

Non-chopping rotation and axial rotation phacoemulsification proved useful in removing lens nuclei of soft to medium density, while quick chopping techniques more effectively removed hard nuclei.

A prospective randomized study included 654 eyes of patients who underwent phacoemulsification and subsequent IOL implantation. Investigators randomized patients to three groups according to phaco technique and then to four groups according to degree of nuclear density.

Primary outcome measures were ultrasound time and mean cumulative dissipated phaco energy.

For grades 1 and 2 nuclei, the non-chopping and axial rotation techniques were more effective than the quick chopping technique in terms of ultrasound time, dissipated phaco energy, best corrected visual acuity, central corneal thickness and endothelial cell loss.

The axial rotation technique was more effective in removing grade 3 nuclei according to the same parameters. However, the rotation techniques were shown to be less effective in removing grade 4 nuclei.

"The non-chopping rotation and axial rotation phacoemulsification techniques are advisable for removal of soft to medium-hard nuclei," the study authors said. "For hard nuclei, chopping techniques are more successful."