Phacoemulsification Techniques and Their Effects on Corneal Endothelial Cells and Visual Acuity: A Review of "Direct-Chop" and "Stop-and-Chop" Approaches Under Topical Anesthesia.

Phacoemulsification is a widely adopted technique in cataract surgery that offers a minimally invasive approach to lens removal and intraocular lens implantation. Among the various methods of phacoemulsification, "direct-chop" and "stop-and-chop" techniques are particularly notable for their efficiency and safety profiles. This review aims to evaluate the effects of these two techniques on corneal endothelial cells and visual acuity, specifically under topical anesthesia. Cataract surgery outcomes hinge on the preservation of corneal endothelial cells and the achievement of optimal visual acuity. Endothelial cell loss can lead to corneal decompensation, while visual acuity is a primary measure of surgical success. The "direct-chop" technique involves the immediate chopping of the lens nucleus after groove creation, reducing phacoemulsification time and energy. Conversely, the "stop-and-chop" technique incorporates a central groove before chopping, offering increased control and safety. This review synthesizes current research and clinical studies to compare these techniques, focusing on their respective impacts on endothelial cell count and postoperative visual acuity. It examines the advantages and disadvantages of each approach, considers the role of surgeon experience, phacoemulsification energy, and anterior chamber stability, and assesses patient outcomes under topical anesthesia. The findings aim to provide insights that can guide surgeons in selecting the most appropriate technique for their patients, ultimately enhancing surgical outcomes by ensuring the preservation of corneal health and the achievement of superior visual acuity.