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

To evaluate a new nucleus removal technique of bore and chop in hard grade three and four nuclear   cataracts in minimizing endothelial cell loss and achieving clear corneas on first post operative day and comparing it with 4 quadrant technique

215 patients were operated by single surgeon using same phaco machine and microscope from October 2019 to December 2022 with bore and chop nucleus removal technique (group I) and compared with195 patients operated with 4 quadrant technique ( group II)

 During nucleus management, a hole was created in centre of nucleus using bevel down flared phaco tip, Bevel was turned up and nucleus engaged and chopped in the bag with blunt tipped chopper with inner cutting edge. The nucleus was chopped into two pieces and each piece was further chopped twice to create 6 pieces and then emulsified at pupillary plane, First postoperative day photographs were taken in all patents to access corneal clarity. The data was compared with 4 quadrant nucleus dividing method. Phaco settings for drilling bore and trenching were energy 70% continuous mode vacuum 150 mm of hg , flow rate 20cc/minute and for chopping and emulsification were 50% power in pulsed mode, vacuum 450 mm of hg and flow rate of 30cc/minute.

 182 patients in group I had clear corneas on first postoperative day compared to 142 in group II  , Twelve patients had striate keratitis in group I as compared to forty two in group II
2 patients in group I had posterior capsule rupture and 3 patients in group II had posterior capsule rupture during nucleus removal. 
the complications were managed with anterior vitrectomy and iris clip lenses in 3 patients and two patients treated with three piece sulcus fixated intra ocular lenses.

 In group I patients less energy was required to divide the nucleus as the phaco tip was embedded in the nucleus  while chopping , compared to 4 quadrant technique where the tip was exposed to endothelium resulting in more endothelial cell loss.
 182 patients in group I had clear corneas on first postoperative day compared to 142 in group II  , Twelve patients had striate keratitis in group I as compared to forty two in group II ,from these  results we can conclude that bore and chop is better technique to achieve clear corneas on first post operative day and reduce endothelial cell loss than conventional 4 quadrant technique.