Abstract:

Objective To evaluate the safety and efficacy of the serrated inner blade nuclear chopper in phacoemulsification for hard nuclear cataracts. Methods This was a prospective, randomized controlled study. A total of 136 patients (136 eyes) with grade Ⅲ-Ⅳ nuclear cataract who received phacoemulsification combined with intraocular lens implantation at Tianjin Medical University Eye Hospital from April 2022 to April 2023 were enrolled. The patients were randomly assigned to either the experimental group or the control group using a random number table. The experimental group received a serrated inner blade nuclear chopper (patent No. ZL 202122407969.9), while the control group received a Nagahara chopper (Trimmer Y-C802). All surgeries were performed by the same experienced cataract surgeon using a standard 2.2 mm micro-incision phacoemulsification technique. Intraoperatively, success of the first chop attempt, occurrence of complications, cumulative dissipated energy (CDE) and ultrasound time (US time) were recorded. Best corrected distance visual acuity (BCDVA), intraocular pressure (IOP) and central corneal thickness (CCT) were measured preoperatively and at 1 day, 1 week and 1 month postoperatively. Corneal endothelial cell density was measured preoperatively and at 1 month postoperatively, and the percentage of endothelial cell loss was calculated. The occurrence of complications during the postoperative follow-up period was recorded. Results The first chop attempt was successful in all patients in the experimental group, while one patient in the control group failed. There was no significant difference between the two groups (P>0.05). No intraoperative complications occurred in either group. Intraoperatively, the experimental group showed significantly lower CDE and US time than those of the control group (both P<0.01). At 1 day and 1 week postoperatively, BCDVA was significantly better in the experimental group than that in the control group (both P<0.01), and CCT was significantly lower in the experimental group than that in the control group (P<0.05). There were no significant differences in IOP at each time point between the two groups (all P>0.05). One month after the operation, the experimental group showed significantly higher corneal endothelial cell density and a lower rate of endothelial cell loss than those of the control group (both P<0.01). There were no postoperative complications during the follow-up period in either group. Conclusion Compared with the Nagahara chopper, the serrated inner blade nuclear chopper is safer and more effective in phacoemulsification for grade Ⅲ-Ⅳ hard nuclear cataracts.

Key words: phacoemulsification, nuclear chopper, hard nuclear cataract, safety and efficacy