Torsional phacoemulsification and intraocular lens implantation without ophthalmic viscoelastic devices in high-grade nuclear cataracts

Abstract

PURPOSE: To compare the clinical results of torsional phacoemulsification and intraocular lens implantation with and without ophthalmic viscoelastic device (OVD) in high-grade nuclear cataracts. MATERIALS AND METHODS: Patients with moderate-to-high-density nuclear cataracts were equally divided into two groups (OVD and balanced salt solution [BSS]) in this prospective, randomized, observer-masked clinical study. Patients with central corneal endothelial cell density (ECD) lower than 1500 cells/mm2, a history of ocular surgery, uveitis, glaucoma, corneal or retinal disorders, zonular weakness, narrow pupil, and shallow anterior chamber were excluded. The main outcome measures included corrected distance visual acuity (CDVA), central corneal thickness (CCT), ECD, total ultrasound time, cumulative dissipated energy, and BSS volume. Postoperative follow-up was performed at day 1, week 1, and months 1 and 3. RESULTS: Each group comprised 32 patients (32 eyes). On postoperative day 1, CCT was significantly high in the BSS group (P = 0.001). The difference in the mean CDVA between the groups was not significant at any time postoperatively (P > 0.062). During the postoperative follow-up, the percentage of mean corneal endothelial cell loss (ECL) in both groups was between 17.3% and 21.9%; the difference between the groups was not statistically significant (P > 0.05). CONCLUSION: In high-density nuclear cataracts, torsional phacoemulsification without OVD may cause transient early corneal edema. However, long-term ECL, CCT, and visual outcomes are comparable to OVD-assisted surgery. When performed with meticulous fluidics, this technique is a safe and cost-effective alternative for dense cataracts.