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  • Cataract/Anterior Segment, Cornea/External Disease

    This study investigated the safety of subluxation phacoemulsification techniques with regard to endothelial cell loss. The results could clarify the risk of choosing the subluxation approach as compared with an endocapsular approach during cataract surgery.

    Study design

    This is a randomized single-blind non-inferiority clinical trial that aimed to determine whether a subluxation supracapsular phacoemulsification technique (garde-a-vous subluxation) was inferior to an endocapsular technique (divide-and-conquer). The primary endpoint was endothelial cell loss at all time points (day 4, months 1 and 12). Secondary endpoints included operative variables such as effective phacoemulsification time and procedure duration.


    The supracapsular subluxation phacoemulsification technique was found to be non-inferior to the endocapsular technique with regard to endothelial cell loss at 3 months follow-up. Supracapsular technique cases were also associated with statistically significant shorter phacoemulsification times and case times.


    There was significant patient dropout at the 12-month follow-up in this study (29%). As such, the study was not sufficiently powered to determine subluxation technique noninferiority to the endocapsular technique at the 12-month followup. In addition, the study was only conducted at 1 clinical site by 1 surgeon, limiting sample size and surgeon variability.

    Clinical significance

    This study shows that supracapsular phacoemulsification techniques are not prone to more endothelial cells loss as compared with endocapsular techniques. These cases also are shorter and use less phacoemulsification time. Surgeons can consider implementing supracapsular techniques for cataract surgeries to diversify their surgical approach to cataract surgery while achieving good visual outcomes and endothelial cell stability.