Steps of

Cataract extraction
 General Preparation
• In addition to general preparation and positioning a small rolled towel
or blanket may be placed under the patient’s shoulder to hyperextend
the neck.
• The OT positions the operating microscope and it is adjusted for focus
• The microscope is then locked into position and rotated away from
the field to allow for prepping and draping. The eye prep extends
from the hairline to mouth and from nose to ear
 Surgical Steps
1. Superior rectus (bridle) suture – is passed to fix the eye in downward gaze
2. Conjunctival flap (fornix based) – is prepared to expose the limbus and hemostasis
is achieved by wet field or heat cautery. All surgeons do not make conjunctival flap
3. Partial thickness groove or gutter- is made through about 2/3 depth of anterior
limbal area from 9.30 to 2.30 o’clock or 150 degrees with the help of a razor blade
knife
4. Corneoscleral section – the anterior chamber is opened with the razor blade knife
or with 3.2mm keratome and section is completed using sclerocorneal scissors.
5. Iridectomy – a peripheral iridectomy may beperformed by using iris forceps and de
wecker’s scissors to prevent ppostoperative pupil block glaucoma
6. Methods of lens delivery – in the ICCE, the lens
can be delivered by any of the following methods
i. Smith indian method - Here the lens is delivered with tumbling
technique by applying pressure on limbus at 6 O'clock position with
lens expressor and counterpressure at 12 O'clock with the lens spatula.
With this method lower pole is delivered first
ii. Cryoextraction - extraction of a cataract through use of a cryoprobe
whose refrigerated tip adheres to and freezes tissue of the lens
permitting
iii. Capsule forceps method - First open the forceps tilt them poke in with
just the right arm. As soon as it pierces the capsule. Close the four sub
tips. And you can start tearing the rexes here. Now look at the motion
iv. Irisophake method – this technique is obsolete and thus not much
use
v. Wire Vectis method - occupies lesser space and conforms to the
shape of nucleus in comparison to the solid vectis. The anterior
chamber is filled with viscoelastic and the nucleus is prolapsed out.
Wire vectis is insinuated beneath the nucleus and the Sinskey's
hook is placed diagonally on the anterior surface of nucleus.
7. Formation of anterior chamber – After the delivery of lens , iris is
reposited into the anterior chamber with the help of iris repository
and chamber is formed by injection sterile air or balanced slat
solution
8. Implantation anterior chamber IOL- held by forceps, is gently slid
into the anterior chamber. Interior haptic is pushed in the inferior
angle at 6 o’clock position and upper haptic is pushed to engage in
the upper angle
9. Closure of incision – Done with 5 to 7 interrupted sutures (8-0, 9-0
or 10-0 nylon )
10. Conjunctival flap – is reposited and secured by wet field cautery.
11. Subconjunctival injection – dexamethasone 0.25 ml and gentamicin
0.5 is given
12. Patching of eye – is done with a pad and sticking plaster or bandage
is applied .shift the patient to bed.