Ophthalmology -- Cataract surgery

1. Cataract surgery
Lara Masri
PPU

2. 1) Intracapsular cataract extraction (ICCE)
• Seldom used today
• Dilating the pupil  Local anasethia
• Incision at limbus.
• Remove the whole lens with its capsule.
• Leaving no support for possible posterior chamber iol implantation iols can be
either sutured to the sclera (transscleral fixation of iol) or the iris in the plane of the
pupil, or placed in the anterior chamber of the eye (anterior to the iris).
• The technique of ICCE is simple, cheap and does not need sophisticated
microinstruments.
• High rate of complications due to the large incision required and pressure placed on
the vitreous body  vitreous prolapse  decompensated cornea.
• Contraindicated in children and young adults with cataracts and any case with
traumatic capsular rupture where intact removal of the lens capsule unit may prove
difficult or incomplete.
• Relative contraindications include high myopia, marfan syndrome, morgagnian
cataracts.
Cataract surgery

3. Clinical Practice in Small Incision
Cataract Surgery Phaco Manual

4. 2) Extracapsular cataract Extraction (ECCE)(Remove the lens,
but the posterior capsule still as it)
• Extended incision (8-10mm) in the cornea.
• After opening the capsule, the bulk of the lens substance is expressed from the eye
with gentle pressure and residual material is aspirated with a cannula.
• The incision must be sutured.
• Used in case of highly advanced cataracts
• (IOL) is placed inside the same capsular bag ( in the posterior capsule)
• Corneoscleral sutures, wound-related problems, and high and irregular astigmatism.
• Less Endophthalmitis

6. 3) Phacoemulsification
• Ultrasound probe introduced through a smaller incision (3mm ) at the limbus.
• 3 corneal incisions.
• An ocular viscoelastic material is injected into the anterior chamber to maintain its
volume and preserve the corneal endothelium
• Ultrasonic probe use sound waves
• Foldable lens
• No suture is required.
• The visibility of the anterior capsule may be enhanced by trypan blue dye in patients
who have poor red reflex.
• The preferred method in the western world

8. cataract surgery complications
 Preoperative :
1. Poor dilatation of the pupil
2. High IOP
3. Anxiety
 operative:
Early Postoperative
Complications
Late Postoperative
Complications
Endophthalmitis (1%) Cystoid macular edema
(endothelial cell loss)
Anterior chamber or vitreous
hemorrhage
Retinal detachment
iris prolapse Bullous keratopathy
Posterior capsule rupture Uveitis
Increased intraocular pressure Posterior capsule
opacification (2ry cataract)

9. Vitreous loss
• If the posterior capsule is damaged during the operation the vitreous gel may come
forward into the anterior chamber
• Risk for glaucoma or may cause retinal traction.
• The gel requires careful aspiration and excision ( vitrectomy )
Iris prolapse
• The iris may protrude through the surgical incision in the immediate postoperative
period.
• It appears as a dark area at the incision site.
• The pupil is distorted.
Posterior capsular tear
• May be a complication during cataract surgery:
• The rate of posterior capsular tear among skilled surgeons is around 2% to 5%.
• It refers to a rupture of the posterior capsule of the natural lens.
• Surgical management may involve anterior vitrectomy and, occasionally, alternative
planning for implanting the intraocular lens, either in the ciliary sulcus, in the
anterior chamber (in front of the iris), or, less commonly, sutured to the sclera.