The Principle of Cataract

Surgery
Andari 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.

Intracapsular delivery of the lens after it has been brought forward

through the pupil with the cryoprobe.

(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.

(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.

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)
2)
3)

Conventional Extracapsular Cataract Extraction

(ECCE),
Manual Small Incision Cataract Surgery (SICS),
Phacoemulsification

Conventional Extracapsular
Cataract Extraction (ECCE)
1. Anterior
capsulotomy

3. Expression of
nucleus

. Care not to aspirate

posterior capsule
accidentally

2. Completion of
incision

4. Cortical cleanup

6. Polishing of
Posterior capsule,
if appropriate

7. Injection of
viscoelastic
substance

8. Grasping of IOL
and coating with
viscoelastic
substance

9. Insertion of
inferior
haptic and optic

10. Insertion of
superior
haptic

11. Placement of
haptics
into capsular
bag

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

3. Sculpting of
nucleus

5. Emulsification of
each quadrant

2. Hydrodissection

4. Cracking of
nucleus

6. Cortical cleanup
and
insertion of IOL