Efficacy and safety of the soft-shell technique in cases with a hard lens nucleus

Purpose: To evaluate the efficacy and safety of the soft-shell technique in reducing corneal endothelial cell damage during cataract surgery in patients with a hard lens nucleus. Setting: Miyata Eye Hospital, Miyakonojo, Miyazaki, Japan. Methods: Sixty eyes of 57 cataract patients with a hard lens nucleus (Emery-Little classification grade 3 or higher) had phacoemulsification using the soft-shell technique with Healon(R) (sodium hyaluronate 1%) and Viscoat(R) (sodium hyaluronate 3.0%-chondroitin sulfate 4.0%) (soft-shell group) or with Healon alone (control group). The visual acuity, intraocular pressure (IOP), flare intensity in the anterior chamber, central corneal thickness, and corneal endothelial cell density were evaluated postoperatively. Results: There were no significant IOP elevations in either group. The mean central corneal thickness in the control group was 539 mum +/- 26.0 (SD) preoperatively and 578 +/- 52.0 mum 1 day after surgery; the increase was significant (P = .0154). There was no significant change in the central corneal thickness in the soft-shell group. There were no statistically significant differences between the 2 groups in uncorrected visual acuity, best corrected visual acuity, IOP, flare intensity in the anterior chamber, and central corneal thickness throughout the follow-up. The rate of endothelial cell loss 3 months after surgery was 6.4% +/- 9.6% in the soft-shell group and 16.3% +/- 9.8% in the control group (P = .0003). Conclusion: The results suggest that the soft-shell technique is safe and effective in protecting corneal endothelial cells during cataract surgery in patients with a hard lens nucleus.