Title: Bore And Chop A New Nucleus Removal Technique To Optimize Endothelial Cell Loss In Hard Grade Iv+ Cataracts And Achieving Clear Corneas On First Post Operative Day

   To evaluate a new nucleus removal technique of Bore and Chop in very hard grade IV+ cataracts in minimizing endothelial loss and achieving clear corneas on 1st postoperative day and comparing it with conventional 4 quadrant technique

215 patients were operated by single surgeon using same phacoemulsification machine and microscope from October 2019 to December 2022 with bore and chop nucleus removal technique (group I) and compared with  195 patents operated with 4 quadrant nucleus removal technique (group II)

After central curvilinear capsulorexis central hole was created in hard core of nucleus with bevel down using flared phaco tip. The bevel was turned up and nucleus re engaged and chopped in the bag with blunt tipped chopper with inner cutting edge. The nucleus was chopped five times to create 6 pieces and then  emulsified in the bag or pupillary plane. In 60% cases topical anesthesia was used and 40% cases peri bulbar anesthesia was used Pre and post operative specular microscope count was done and compared. The data was compared with  4 quadrant method. First postoperative day photographs were taken in all patents to access corneal clarity.

Average endothelial cell loss in bore and chop technique was found to be between 10% and 18% and in 4 quadrant technique was 15%  to 30%.

182 patients in group I had clear corneas on first postoperative day compared to 142 patients in group II . 12 patients  had striate keratitis in group I compared to 42 in group II 

In group I patients less energy was required to divide the nucleus as the phaco tip was embedded in nucleus compared to 4 quadrant technique where the tip was exposed to endothelial surface resulting in more endothelial cell damage.

From the results , 182 patients achieving clear cornea on day one in group I compared to 142 patients in group II and average endothelial cell loss of 10 to 18% in group. I and 15-35% in group II we can conclude that Bore and Chop is better technique to reduce endothelial cell loss than conventional 4 quadrant technique.