The Principle of Cataract SurgeryAndari Putri Wardhani

ICCE (Intra-Capsular Cataract Extraction) In this technique, the entire cataractous lens along with the

intact capsule is removed. Indications:

At present the only indications of ICCE is markedly subluxated and dislocated lens.

1. In this surgery, the physician creates a large incision in the eyeball and inserts medicine, allowing the “zonular fibers” that are securing the lens in place to soften.

2. Liquid nitrogen is then smeared on the lens in order to freeze it by using a probe.

3. This probe is then gradually pulled off of the eye, removing the natural lens along with it.

4. An intraocular lens is then placed in front of the iris, and a number of stitches are required to close the eye until it heals.

(B) The cornea has a concave surface, showing that the eye is soft without forward pressure from the vitreous body. The anterior chamber is reformed with a physiological solution.  

(A) The pupil constricts spontaneously as soon as the maximal diameter of the lens is through. In the lower left of the figure, the swab, moistened by aqueous and holding back the iris, is shown, as cryo traction slides the lens out of the eye.

Intracapsular delivery of the lens after it has been brought forward through the pupil with the cryoprobe.

Intraocular lenses

Because the capsular bag has been removed, the choice of IOL support is limited to the angle, the iris, or to the ciliary sulcus support (fixated by suture).

ECCE (Extra-Capsular Cataract Extraction) This involves removal of the cataract, in this technique major

portion of anterior capsule with epithelium, nucleus and cortex are removed; leaving behind intact posterior capsule.

The surgical techniques of ECCE presently in vogue are:

1) Conventional Extracapsular Cataract Extraction (ECCE),

2) Manual Small Incision Cataract Surgery (SICS),

3) Phacoemulsification

Conventional Extracapsular Cataract Extraction (ECCE)

1. Anterior capsulotomy

2. Completion of incision

3. Expression of nucleus

4. Cortical cleanup

6. Polishing of Posterior capsule, if appropriate

5. Care not to aspirate posterior capsule accidentally

8. Grasping of IOL and coating with viscoelastic substance

7. Injection of viscoelastic substance

9. Insertion of inferior haptic and optic

11. Placement of haptics into capsular bag

10. Insertion of superior haptic

12. Dialling of IOL into horizontal position

SICS (Small Incision Cataract Surgery) This is a better technique than ECCE with the incision being

about 5-6mm. Non-foldable IOL may be placed. There are no stitches required to close the incision.

PHACO-EMULSIFICATION• Phaco is a technique employed for the removal of cataracts using

machine and micro-surgical instruments.• This surgery involves the removal of the clouded, opacified lens

and its replacement with a synthetic, clear foldable intra-ocular lens through a very small micro-incision of 2.8 mm.

1. Capsulorrhexis 2. Hydrodissection

3. Sculpting of nucleus

4. Cracking of nucleus

5. Emulsification of each quadrant

6. Cortical cleanup and insertion of IOL