A Comparative Study Between Divide and Conquer, Stop and Chop, and Direct Chop Techniques Used In Phacoemulsification: A Prospective Comparative Study

Abstract

Background: Phacoemulsification is the gold standard surgical procedure for cataract extraction. The technique used for nuclear fragmentation significantly influences surgical efficiency, ultrasound energy utilization, endothelial preservation, and postoperative recovery. Divide and Conquer, Stop and Chop, and Direct Chop are among the most commonly employed nucleotomy techniques.

Methods: This prospective comparative study was conducted in the Department of Ophthalmology, JLN Medical College and Hospital, Ajmer. A total of 150 patients with immature senile cataract undergoing phacoemulsification were enrolled and equally allocated into three groups: Divide and Conquer (Group A, n=50), Stop and Chop (Group B, n=50), and Direct Chop (Group C, n=50). Patients were evaluated preoperatively and postoperatively on days 7, 14, and 28. Outcome measures included best corrected visual acuity (BCVA), intraocular pressure (IOP), central corneal thickness (CCT), macular thickness, phaco power percentage, and total phacoemulsification time.

Results: Baseline demographic and clinical characteristics were comparable among the groups. Significant postoperative improvement in BCVA was observed in all groups without significant intergroup differences. Direct Chop demonstrated the shortest mean phaco time (5.29 ± 2.16 seconds), followed by Stop and Chop (12.66 ± 2.76 seconds) and Divide and Conquer (21.06 ± 4.72 seconds) (p<0.05). Mean phaco power was significantly higher in the Divide and Conquer group. Postoperative corneal edema, assessed by CCT, was greatest in the Divide and Conquer group and least in the Direct Chop group. Macular thickness remained comparable across all groups throughout follow-up.

Conclusion: All three nucleotomy techniques provided excellent visual outcomes following phacoemulsification. However, Direct Chop demonstrated superior surgical efficiency with reduced ultrasound energy usage, shorter phaco time, and better corneal preservation, suggesting it may be the preferred technique in routine cataract surgery.