{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T06:16:01Z","timestamp":1788243361537,"version":"build-2803163510"},"reference-count":30,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T00:00:00Z","timestamp":1788048000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Objectives: To describe intraoperative and postoperative outcomes of the Eight-Chop Technique in elderly patients, with particular attention to nonagenarian patients undergoing cataract surgery. Methods: This retrospective study included consecutive eligible eyes undergoing Eight-Chop phacoemulsification and posterior chamber intraocular lens implantation at a single clinic. Eyes were stratified by age at surgery into 70\u201379 years, 80\u201389 years, and \u226590 years groups. Sixty eyes were included in each younger group, and all 49 eligible nonagenarian eyes were included. Eyes were not intentionally excluded from the younger groups because of poor pupillary dilation, zonular weakness, white cataract, pseudoexfoliation, glaucoma, age-related macular degeneration, or advanced nuclear grade. Preoperative characteristics, intraoperative parameters, best-corrected visual acuity (BCVA), intraocular pressure, and corneal endothelial cell density (CECD) were evaluated. Linear mixed-effects models accounted for fellow-eye correlation. Results: A total of 169 eyes were analyzed. The \u226590-year cohort had greater baseline complexity; intraoperative differences were descriptive, with the highest operative time, phacoemulsification time, aspiration time, cumulative dissipated energy, and irrigation fluid volume (all p &lt; 0.001). Postoperative BCVA improved from baseline in all groups. Mean CECD loss at 19 weeks was \u22121.3 \u00b1 5.7%, \u22120.7 \u00b1 5.7%, and 3.5 \u00b1 9.2% in the 70\u201379-, 80\u201389-, and \u226590-year groups, respectively. No serious intraoperative complications occurred. Conclusions: The Eight-Chop Technique was used across elderly age groups, including nonagenarian patients. Observed age-group differences represent associations in this retrospective dataset and do not establish causal age effects or comparative superiority, safety, or endothelial protection of the technique.<\/jats:p>","DOI":"10.3390\/jcm15176737","type":"journal-article","created":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T05:45:13Z","timestamp":1788241513000},"page":"6737","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Eight-Chop Technique in Nonagenarian Patients: Real-World Intraoperative and Postoperative Outcomes"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6255-8745","authenticated-orcid":false,"given":"Tsuyoshi","family":"Sato","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Sato Eye Clinic, 3-3 Nemoto, Matsudo-Shi 271-0077, Chiba-Ken, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,30]]},"reference":[{"key":"ref_1","unstructured":"GBD 2019 Blindness and Vision Impairment Collaborators, and Vision Loss Expert Group of the Global Burden of Disease Study (2021). Causes of blindness and vision impairment in 2020 and trends over 30 years, and prevalence of avoidable blindness in relation to VISION 2020: The Right to Sight: An analysis for the Global Burden of Disease Study. Lancet Glob. Health, 9, e144\u2013e160."},{"key":"ref_2","unstructured":"Vision Loss Expert Group of the Global Burden of Disease Study, and GBD 2019 Blindness and Vision Impairment Collaborators (2024). Global estimates on the number of people blind or visually impaired by age-related macular degeneration: A meta-analysis from 2000 to 2020. Eye, 38, 2070\u20132082."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1229","DOI":"10.1016\/j.ophtha.2010.11.023","article-title":"Cataract surgery complications in nonagenarians","volume":"118","author":"Tseng","year":"2011","journal-title":"Ophthalmology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1111\/jgs.12590","article-title":"Clinical Outcomes of Cataract Surgery in Very Elderly Adults","volume":"62","author":"Young","year":"2014","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"328","DOI":"10.5301\/ejo.5000706","article-title":"Predictive modeling of risk factors and complications of cataract surgery","volume":"26","author":"Gaskin","year":"2016","journal-title":"Eur. J. Ophthalmol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1120","DOI":"10.1038\/eye.2008.203","article-title":"Visual outcome following cataract extraction in patients aged 90 years and older","volume":"23","author":"Rosen","year":"2009","journal-title":"Eye"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"210716","DOI":"10.1155\/2015\/210716","article-title":"Endothelial cell loss after phacoemulsification according to different anterior chamber depths","volume":"2015","author":"Hwang","year":"2015","journal-title":"J. Ophthalmol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1097\/j.jcrs.0000000000001474","article-title":"Comparison of corneal endothelial cell loss in FLACS: Impact on endothelial cells in different regions","volume":"50","author":"Altansukh","year":"2024","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"708","DOI":"10.3928\/1081597X-20170731-01","article-title":"Comparison of Corneal Endothelial Cell Loss Between Two Femtosecond Laser Platforms and Standard Phacoemulsification","volume":"33","author":"He","year":"2017","journal-title":"J. Refract. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"3904","DOI":"10.4103\/ijo.IJO_1304_22","article-title":"Corneal endothelial changes following cataract surgery in hard nuclear cataract: Randomized trial comparing phacoemulsification to manual small-incision cataract surgery","volume":"70","author":"Singh","year":"2022","journal-title":"Indian J. Ophthalmol."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Sato, T. (2025). Minimizing Endothelial Cell Loss in Hard Nucleus Cataract Surgery: Efficacy of the Eight-Chop Technique. J. Clin. Med., 14.","DOI":"10.20944\/preprints202410.0036.v2"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1097\/j.jcrs.0000000000001141","article-title":"Efficacy and safety of the eight-chop technique in phacoemulsification for patients with cataract","volume":"49","author":"Sato","year":"2023","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"624182","DOI":"10.2147\/OPTH.S624182","article-title":"The Eight-Chop Technique in Cataract Surgery: A Conceptual and Narrative Review of a Segmentation-First Strategy","volume":"20","author":"Sato","year":"2026","journal-title":"Clin. Ophthalmol."},{"key":"ref_14","unstructured":"Emery, J.M., and McIntyre, D.J. (1983). Kelman phacoemulsification; patient selection. Extracapsular Cataract Surgery, CV Mosby."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2291","DOI":"10.1080\/00949655.2012.690763","article-title":"Adaptive fitting of linear mixed-effects models with correlated random-effects","volume":"83","author":"Zhang","year":"2013","journal-title":"J. Stat. Comput. Simul."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1261","DOI":"10.1016\/j.jcrs.2010.02.014","article-title":"Pseudoexfoliation: High risk factors for zonule weakness and concurrent vitrectomy during phacoemulsification","volume":"36","author":"Shingleton","year":"2010","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1111\/aos.13110","article-title":"Outcome of phacoemulsification and intraocular lens implantation in eyes with pseudoexfoliation and weak zonules","volume":"95","author":"Shingleton","year":"2017","journal-title":"Acta Ophthalmol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1693","DOI":"10.1016\/j.ophtha.2004.02.008","article-title":"Comparison of various pupil dilatation methods for phacoemulsification in eyes with a small pupil secondary to pseudoexfoliation","volume":"111","author":"Akman","year":"2004","journal-title":"Ophthalmology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"77","DOI":"10.4103\/sjopt.sjopt_226_23","article-title":"Comparative assessment of the corneal endothelium following phacoemulsification surgery in patients with type II diabetes and nondiabetes","volume":"39","author":"Akansha","year":"2025","journal-title":"Saudi J. Ophthalmol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1016\/S0886-3350(99)00462-9","article-title":"Endothelial cell loss after phacoemulsification: Relation to preoperative and intraoperative parameters","volume":"26","author":"Walkow","year":"2000","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Perone, J.M., Luc, M.S., Zevering, Y., Vermion, J.C., Gan, G., and Goetz, C. (2024). Narrative review after post-hoc trial analysis of factors that predict corneal endothelial cell loss after phacoemulsification: Tips for improving cataract surgery research. PLoS ONE, 19.","DOI":"10.1371\/journal.pone.0298795"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"6616","DOI":"10.19082\/6616","article-title":"Changes in corneal thickness and corneal endothelial cell density after phacoemulsification cataract surgery: A double-blind randomized trial","volume":"10","author":"Bamdad","year":"2018","journal-title":"Electron. Physician"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1136\/bjophthalmol-2018-313723","article-title":"Comparison of changes in corneal endothelial cell density and central corneal thickness between conventional and femtosecond laser-assisted cataract surgery: A randomised, controlled clinical trial","volume":"104","author":"Dzhaber","year":"2020","journal-title":"Br. J. Ophthalmol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1307","DOI":"10.1016\/j.jcrs.2013.05.033","article-title":"Corneal endothelial cell loss and corneal thickness in conventional compared with femtosecond laser-assisted cataract surgery: Three-month follow-up","volume":"39","author":"Schultz","year":"2013","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_25","first-page":"281","article-title":"Effect of torsional mode phacoemulsification on cornea in eyes with\/without pseudoexfoliation","volume":"8","author":"Demircan","year":"2015","journal-title":"Int. J. Ophthalmol."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Sato, T. (2026). Postoperative Flare and Corneal Endothelial Cell Loss After Eight-Chop Technique Phacoemulsification: A Prospective Observational Study. J. Clin. Med., 15.","DOI":"10.3390\/jcm15020557"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Dinarvand, D., Panthakey, J., Hassan, A., and Ahmed, M.H. (2024). Frailty and Visual Impairment in Elderly Individuals: Improving Outcomes and Modulating Cognitive Decline Through Collaborative Care Between Geriatricians and Ophthalmologists. Diseases, 12.","DOI":"10.3390\/diseases12110273"},{"key":"ref_28","first-page":"e65469","article-title":"Cataract Surgery and Mental Health: A Comprehensive Review on Outcomes in the Elderly","volume":"16","author":"Dhawale","year":"2024","journal-title":"Cureus"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1104","DOI":"10.1136\/bmj.322.7294.1104","article-title":"Effect of increasing age on cataract surgery outcomes in very elderly patients","volume":"322","author":"Wong","year":"2001","journal-title":"BMJ"},{"key":"ref_30","first-page":"191","article-title":"Common causes of visual impairment in the elderly","volume":"10","year":"2021","journal-title":"Med. Hypothesis Discov. Innov. Ophthalmol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/17\/6737\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T05:55:45Z","timestamp":1788242145000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/17\/6737"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,30]]},"references-count":30,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["jcm15176737"],"URL":"https:\/\/doi.org\/10.3390\/jcm15176737","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,30]]}}}