Postoperative Flare and Corneal Endothelial Cell Loss After Eight-Chop Technique Phacoemulsification: A Prospective Observational Study

Objectives: The Eight-chop technique is a mechanically based nuclear segmentation method designed to improve surgical efficiency and reduce intraocular tissue stress during phacoemulsi-fication. Early postoperative aqueous flare serves as an objective indicator of surgical invasive-ness, whereas corneal endothelial cell density (CECD) loss represents a structural measure of en-dothelial injury. Although both parameters are clinically important, their relationship has not been systematically investigated in the context of this newer mechanical fragmentation ap-proach. Methods: This prospective observational study included 118 eyes from 70 non-diabetic patients undergoing uncomplicated Eight-chop phacoemulsification. Aqueous flare was meas-ured preoperatively and at postoperative Day 1, Day 7, Week 7, and Week 19 using laser flare photometry. CECD was evaluated preoperatively and at Weeks 7 and 19. Changes over time were analyzed using paired t-tests. Linear mixed-effects models (random intercept = patient ID) were constructed to assess predictors of CECD loss and postoperative intraocular pressure (IOP) reduction. Explanatory variables included Day 1 flare, age, preoperative CECD, nucleus hard-ness (Emery–Little grade), cumulative dissipated energy (CDE), and irrigation fluid volume. Re-sults: Postoperative flare increased significantly at all time points (all p < 0.001), peaking on Day 7 (16.7 ± 9.21 photon counts/ms). CECD loss was extremely small, averaging 1.38% at Week 7 and 1.46% at Week 19. In mixed-effects models, Day 1 flare was not associated with CECD loss at Week 7 (p = 0.35) or Week 19 (p = 0.85). Significant predictors of CECD loss included Emery–Little grade (p = 0.004 at Week 7; p = 0.025 at Week 19), with borderline contributions from CDE and irrigation volume. IOP decreased significantly at Weeks 7 and 19; however, Day 1 flare did not predict IOP reduction. Conclusions: Eight-chop phacoemulsification produced uniformly low postoperative inflammation and exceptionally small corneal endothelial cell loss. Early postop-erative flare did not predict CECD loss, suggesting that the Eight-chop technique provides a highly standardized, low-invasiveness surgical environment. These findings suggest that the Eight-chop technique lowers ultrasound energy requirements and may help reduce corneal endo-thelial stress relative to standard phacoemulsification.