How Many Types Of Cataract Surgery Are There?

There are various types of surgical management of cataract but mainly there are three types-

1. Extra-capsular cataract extraction or ECCE
2. Phacoemulsification
3. Intra-capsular cataract extraction or ICCE

Before starting with surgical management of cataract, it is not harmful to know some interesting facts about the disease. The term cataract is derived from a Greek word known as ‘katarraktes’, means to ‘waterfall’. The word was coined in the assumption that decreased vision is caused by the flow of an abnormal humor in front of eye lens. In the present era, cataract is the development of any kind of opacity inside the eye lens or its capsule.

1. Extra-Capsular Cataract Extraction (ECCE)

   There are multiple ways to carry out the procedure of removing extracapsular material from the lens in order to attain clear vision. During such procedures, a major part of anterior capsule is removed along with cortex, epithelium and the nucleus. Thus, only intact posterior part of the capsule is left behind.

   Indications: Techniques of ECCE are among the mostly used techniques in removal of almost every type of childhood as well as adulthood cataract except where it is contraindicated.

   Contraindications: There is only one absolute contraindication of extracapsular cataract extraction surgery and it is dislocated or subluxated lens which has to be marked enough to affect the surgical procurement.

   Different Techniques of ECCE

   • Conventional extracapsular cataract extraction surgery
   • Manual small incision extracapsular cataract extraction surgery or SICS
   • Phacoemulsification

   Conventional Extracapsular Cataract Extraction Surgery

   • Superior rectus suturing.
   • Formation of fornix based conjuctival flap.
   • Formation of gutter or partial groove.
   • Entry inside anterior chamber.
   • Entry of viscoelastic material inside the chamber through micro pore needle injection.
   • Anterior capsulotomy.
   • Extraction of anterior capsule.
   • Formation of coronoscleral section.
   • Hydro dissection.
   • Extraction of nucleus.
   • Cortex aspiration.
   • Intra-ocular lens implantation.
   • Closing of the incision.
   • Viscoelastic material removal.
   • Reposition of conjuctival flap.
   • Subconjuctival injection.
   • Patching of the eye.

   Manual Small Incision Cataract Surgery or SICS

   This technique is gaining popularity because of its advantages over conventional ECCE as well as phacoemulsification technique. Peculiarity of this procedure lies in self sealing valvular sclerocorneal incision given during the surgery.

2. Phacoemulsification

   This technique is the surgery of choice in the modern era of ophthalmology. In this surgery a foldable posterior chamber intraocular lens implantation is done so, this technique has to be differing from other techniques. Phacoemulsification differs from conventional ECCE and SICS in multiple ways which are mentioned under.

   • Requirement of a very small (3 mm) clear corneal incision.
   • Continuous curvilinear capsulorrhexis is preferred over capsulotomy.
   • Hydro dissection to felicitate rotation of the nucleus and its manipulation.
   • Emulsification of the nucleus at ultrasonic speed of 40000 times per second.
   • Rest of the procedure does not carry much important except for the fact that injury to the cornea is kept as less as possible so that recovery can occur easily within lesser time period.

3. Intra-Capsular Cataract Extraction (ICCE)

   As it is already mentioned, that extracapsular cataract extraction surgery is the surgery of choice among ophthalmologists. The ICCE has become an old-age technique and is rarely used now globally. But, it was the efficiency of the procedure that it was used for more than a millennium to cure the patients of cataract.

   There are different steps carried out during the procedure, basic ones are mentioned below-

   • Superior rectus suturing.
   • Formation of fornix based conjuctival flap.
   • Formation of gutter or partial groove.
   • Coronoscleral section.
   • Iridectomy.
   • Delivery of the lens.
   • Formation of anterior chamber.
   • ACIOL or implantation of anterior chamber.
   • Incision closing.
   • Closure of conjuctival flap.
   • Subconjuctival antibiotic injection.
   • Application of the eye patch.

References:

Also Read:

• Cataracts: Types, Causes, Signs, Tests, Treatment- Surgery, Home Remedies, Prevention
• Congenital or Acquired Cataracts in Children
• Cataract Eye Surgery: What To Expect, Dos & Don’ts, Dry Eye Syndrome