Extracapsular cataract extraction

Extracapsular cataract extraction (ECCE) is a type of cataract surgery where the surgeon removes the cloudy lens of the eye (the cataract) but leaves the majority of the lens capsule intact. This procedure is performed to restore vision that has been impaired by a cataract. ECCE is one of several methods used to treat cataracts, with the choice of procedure depending on the specific characteristics of the cataract and the patient's overall eye health.

Procedure

During an extracapsular cataract extraction, the surgeon makes an incision on the side of the cornea to access the lens. Using surgical tools, the surgeon carefully opens the front portion of the lens capsule and removes the hard nucleus and the soft cortical material of the lens. The back portion of the capsule is left in place to serve as a support for the intraocular lens (IOL) implant that will replace the natural lens. The IOL is inserted into the remaining capsule, where it helps to focus light onto the retina at the back of the eye.

Indications

ECCE is typically indicated for patients with advanced or very dense cataracts, where phacoemulsification (a more common and less invasive cataract surgery technique) may not be the best option. It may also be chosen for patients with certain eye conditions that make phacoemulsification more challenging or risky.

Advantages and Disadvantages

The main advantage of ECCE over more invasive cataract surgery methods is its ability to handle very dense or advanced cataracts effectively. However, ECCE usually requires a larger incision than phacoemulsification, which can lead to a longer recovery time and a higher risk of complications, such as astigmatism or wound healing issues.

Recovery

After the surgery, patients may need to wear an eye patch or protective shield for a short period. Eye drops are often prescribed to prevent infection and reduce inflammation. While some improvement in vision is usually noticed soon after the surgery, full recovery and stabilization of vision may take several weeks.

Risks and Complications

As with any surgery, there are risks associated with ECCE, including infection, bleeding, inflammation, and increased intraocular pressure. There is also a risk of posterior capsule opacification (PCO), where the back of the lens capsule that is left in place becomes cloudy over time, potentially requiring further treatment.

Comparison with Other Techniques

ECCE is less commonly performed today than in the past, largely due to the advancement and increased safety of phacoemulsification. However, it remains an important option for certain cases where phacoemulsification is not suitable. Another method, manual small incision cataract surgery (MSICS), is also used, especially in areas where access to the expensive equipment required for phacoemulsification is limited.