A comparative study of cystotome-assisted prechop technique with stop-and-chop technique for pseudoexfoliation syndrome with cataract

Background

Pseudoexfoliation syndrome (PEX) has a high incidence in Uygur population and usually leads to secondary glaucoma and complicated cataract.The abnormal change of lens tissue and degeneration of zonular fibers bring a lot of difficulties for phacoemulsification (phaco) with intraocular lens implantation, especially stop-and-chop phaco technique.Prechop technique is a new choping technology, but its application in PEX with cataract is less.

Objective

This study was to compare the efficacy and safety of pre chop phaco technique and stop-and-chop phaco technique for PEX combined cataract.

Methods

A randomized controlled Clinical trial was designed.Forty-one eyes of 41 patients with PEX combined cataract of Ⅲ degree of nucleus were enrolled in People’s Hospital of Hetian District from March 2015 to January 2016.The patients were randomized into the prechop group and stop-and-chop group according to random nubmer table, and cystotome-assisted prechop phaco surgery and stop-and-chop phaco surgery were performed in different groups, respectively.The effective phaco duration, corneal endothelium loss rate, cornea edema eye number after operation, vision outcomes and complications were compared between the two groups.

Results

The mean effective phaco duration was 14.0 (13.0, 16.5) minutes and 18.5 (16.5, 24.0) minutes in the prechop group and stop-and-chop group, with a significant difference between them (Z=17.354, P<0.01). The corneal endothelial cells were (2 101.90±209.08)/mm in the prechop group, and the number was similar to (2 002.30±207.04)/mm of the stop-and-chop group (t=-1.530, P=0.134). Corneal endothelial cell lossing rate was (8.27±2.23)% in the prechop group, which was lower than (13.09±4.26)% in the stop-and-chop group (t=3.810, P=0.001). The BCVA was better in the prechop group than that in the stop-and-chop group in postoperative day 3 (P=0.044), and the corneal edema degree was not signigicantly different in postoperative day 1 and day 3 between the two groups (P=0.221, 0.446). Intraoperative complication was rapture of zonule and occurred in 1 eye and 2 eyes in the prechop group and stop-and-chop group, respectively.

Conclusions

Compared with the stop-and-chop phaco technique, the prechop phaco tequnique can decrease intraoperative complication, lighten the postoperative damage of corneal endothelial cells and accelerate visual rehabilitation in PEX combined with cataract patients.

Cataract extraction/methods; Phacoemulsification/methods; Lens nucleus, crystalline/surgery; Peudoexfoliation; Treatment outcome; Comparative study; prechop technique; Stop-and-chop technique