Supplementary file 1_Enhanced efficiency and endothelial protection of the intraocular lens shell technique in phacoemulsification: a retrospective stratified analysis by nuclear hardness.docx

This study evaluated the safety and efficiency of the IOL-shell technique and explored its effects across nuclear hardness subgroups.</p>Methods<p>This retrospective study included 200 patients undergoing phacoemulsification: 100 treated with the IOL-shell technique and 100 treated with the conventional technique.

Outcomes included operative time, cumulative dissipated energy (CDE), corneal endothelial cell loss, posterior capsule rupture (PCR), corneal edema, and best-corrected visual acuity (BCVA) at 1 month. Subgroup and interaction analyses were performed according to nuclear hardness (≥ Grade IV vs. ≤ Grade III).</p>Results<p>Baseline characteristics were comparable between groups. Compared with the conventional group, the IOL-shell group had shorter operative time (12.79 ± 2.00 vs. 15.13 ± 2.52 min, P < 0.001), lower CDE (8.36 ± 2.05 vs. 12.03 ± 2.78 units, P < 0.001), less endothelial cell loss (10.74 ± 3.55% vs. 14.59% ± 3.95%, P < 0.001), a lower corneal edema rate (18.0% vs. 32.0%, P = 0.022), and better 1-month BCVA (0.29 ± 0.08 vs. 0.36 ± 0.12 logMAR, P < 0.001).