Purpose: To compare the clinical performance of the divide and conquer and tilt and tumble techniques in cataract surgery with respect to surgical efficiency, safety and energy usage. Setting: The research was conducted at two private clinics specialized in cataract surgeries located in the southern region of Sweden. Design: The study was a prospective randomized controlled trial. Methods: A total of 535 patients undergoing cataract surgery were randomized to either divide and conquer or tilt and tumble. Primary outcomes included total surgery time, phacoemulsification time, ultrasound time, cumulative dissipated energy (CDE) and intraoperative complications. Postoperative visual acuity, intraocular pressure (IOP) and, for a subset, central retinal thickness (CRT), were assessed at follow up. Results: Tilt and tumble demonstrated significantly shorter operation time, 4.68 compared to 6.50 minutes (p< 0.001), phaco time 60 versus 148 seconds (p< 0.001) and ultrasound time, 32 versus 40 seconds (p< 0.001) compared to divide and conquer. Baseline characteristics, Energy expenditure (CDE), intraoperative complications and postoperative outcomes did not differ significantly between groups. Conclusion: Our results revealed that the tilt and tumble technique is notably swifter and demonstrates comparable safety, energy consumption and postoperative outcome compared to divide and conquer. This sheds light on the potential benefits of the tilt and tumble technique ultimately enhancing patient care. Keywords: phacoemulsification, cataract surgery, tilt and tumble, divide and conquer
Ursberg et al. (Sun,) studied this question.