Extra capsular cataract extraction (ECCE) is
B i.e. Lens extracted with posterior capsule left behind Cataract Surgeries Intracaspular cataract extraction (ICCE) Extracapsular cataract extraction (ECCE) Phacoemulsification General principles Whole lens removed with intact capsuleQ Lens nucleus and coex removed leaving the capsular bag behindQ Same as ECCE Dilatation of pupil Not required Required Required Magnification Binocular loupe or microscope Microscope Microscope Incision Large, 180deg, 10-12mm Medium, 120deg, 7-8 mm, from 10 O'clock to 2 O'clock Small, 30deg, 3.2-3.5mm A,,...-----,A Larger Smalle Smallest Incision Incision Incision Lens Removal Intact lens delivered - Capsulotomy - Nucleus -'Can-opener' or rhexis -Rhexis delivery -Manual sliding -Phacoemulsification - Coex removal -Irrigation aspiration, manual or automated -Irrigation aspiration, automated Intraocular lens Anterior chamber or none Posterior chamber 'in the bag' Posterior chamber 'in the bag' Sutures Required, continuous or interrupted (5-7) Required, continuous or interrupted (3-5) Not required Method Entire cataractous lens Central pa of anterior capsule It is basically an ECCE along with intact capsule is is removed along with nucleus with a instrument called removed & coex of lens. The posterior capsule & equatorial and peripheral pa of anterior capsule is left inside. phacoemulsifier, which emulsifies lens nucleus and coical matter by ultrasonic vibration (1 mm titanium needle vibrating 40,000 times/second). Then it is removed by simultaneous irrigation aspiration. Indications * Subluxated or dislocated * < 40 years age * Same as ECCE, it is lens Q is absolute indication * High myopia with degenerated fluid vitreous overall method of choice * Camp surgery, no facility of micro surgery, untrained surgeon may be other reasons * Procedure of choice over ICCE Contraindi- * < 40 years age Q (due to * Markedly subluxated or * Same as ECCE cation strong zonules) dislocated lens Advantages * No chances of developing * Posterior chamber IOL can be Same as ECCE uveitis & secondary implanted + glucoma due to lens * Less chances of * Small incision sutureless paicle (as lens is 1. Endopthalmitis Q cataract surgery removed along with capsule) 2. Vitreous traction & loss leading to less chances of * Rapid wound healing, shoer convalescence * No chances of after * Cystoid maculaer oedema Q * Early stabilization of cataract, since there is no * Tractional RD Q refraction with minimal posterior capsule * Pupillary block or no refraction. * Simple, quick, cheap & suitable for camp surgery * Vitreous tounch syndrome Q * Vitreous wick syndrome Disadvantage * All advantes of ECCE & * All advantages of ICCE are Same as ECCE phacoemulsification are disadvantages of ECCE e.g. + disadvantages of ICCE e.g. more astigmatism, PC-IOL can't be implanted possibility of after cataract, lens paicle induced glucoma & uveitis * Costly & most difficult
Posterior capsulectomy only
Lens extracted with posterior capsule left behind
Posterior capsulectomy with no lens removal
Anterior capsulectomy with no lens removal