CATARACT

EXTRACTION
EYE DEPARTMENT
PMC-AJK
METHODS
• Couching (criminal)
• ECCE (discontinued)
• ICCE (discontinued)
• ICCE with AC IOL (discontinued)
• ECCE with PC IOL (most common)
• Phacoemulsification with foldable IOL (most common in developed countries)
• MSICS with PC IOL (manual phaco/poor mans phaco) (gaining popularity)
• Laser assisted cataract surgery (future trend)
AIMS OF SURGERY
Faster Visual rehabilitation
Smallest incision

Minimum complications
Unaided good vision
IOL implantation
To reduce astigmatism ( keep wound as peripheral and as small as possible)
Incision caused weakening of wound and a plus cylinder in axis of wound
Up to 0.75 diopter acceptable
ICCE large wound 3 diopter astigmatism
ECCE 2-2.5 diopter astigmatism
MSICS 0.75 diopter astigmatism
Phaco 0.50 diopter astigmatism
HISTORY OF CATARACT SURGERY
• The word “cataract” stems from the Greek word for “waterfall,”

• In 8th century BC (as determined from Sanskrit manuscripts), the

first cataract operation “couching” was  performed By Shustra

• This method consisted of pushing the cataractous lens, moving it

away from the pupil (visual axis), and letting it fall in the vitreous
cavity towards the rear and bottom of the eye ball. 
• in 29 A.D., a method called “needling” or “discussion” was used in
De Medicinae by Aulus Cornelius in Rome  This procedure slices
the cataract into multiple particles, allowing for them to be easily
absorbed.

• in 1748 Jacques Daniel in Paris, performed first ECCE

• A huge breakthrough occurred in the 1940s in England when Harold
Ridley created the intraocular lens.

• In 1957, Barraquer of Spain used alpha-chymotrypsin to

enzymatically dissolve the zonules for removal of the lens.

• In 1961, Krawicz of Poland introduced Cryo-surgery that removed

the lens with a tiny probe attached by freezing a small area on the
surface of the cataract.
• The most significant change marked by the modern era was the
introduction of phacoemulsification surgery in 1967 by Dr. Charles
Kelman

• It was not until the late 1840s that general anesthesia was
introduced for surgical procedures. By 1884, anesthesia in the form
of eye drops (cocaine) was developed.
• Investigations
• Routine Blood CP, ESR, RBS,
• Urine RE
• Screening for Hepatitis B and C
• Bio-metery
• Any other investigation necessary due to the co-existing medical
disorder
PRE OPERATIVE MEDICATIONS

• Sedation
• Antibiotic drops
• IOP lowering drug (AZM)
• Continue medication of DM HT
• Immediately pre op
• 1. antibiotic
• 2. mydriatic
• 3. topical anaesthetic
PHACOEMULSIFICATION
•Retro-bulbar Anesthesia/ Topical anesthesia
•Povidone-iodine painting of lids
•Draping
•Main incision with 3.2mm keratome
•Side port incisions with 1.2 mm side port knife
•Injection of methylene blue in the AC
•Washing of AC and filling of AC with OVD
(methylcellulose)
•Capsulorrexhis
•Hydro-dissection / delineation
•Stop and chop phaco
•Removal of epi-nuclear cortex with simeco
cannula
•Implantation of foldable IOL
•Removal of OVD
•Injection of Miochol to miose the pupil
•Hydration of incisions to make them water tight
•Sub Conjunctival Injection of antibiotic / steroid
•Pad the eye
POST OPERATIVE MEDICATION

• Systemic analgesics
• systemic antibiotic
• antibiotic steroid combination drops
• Mydriatic drops
POST OPERATIVE PRECAUTIONS

• Avoid heavy weights lifting

• Avoid padding or patching
• Avoid straining for cough and in washroom
• Avoid sijda in nimaz for I week
• Avoid washing eyes with tap water
• Soft diet for 3 days
• Follow up at first post op day
• After every two weeks and
• Refraction at 6 weeks
VIDEOS
SIGNS OF APHAKIA

• Aphakic glasses
• Limbal scar
• Deep anterior chamber
• Iridectomy
• Iridodonesis
• Jet black pupil
DUE TO ANESTHETIC (DRUG AND
TECHNIQUE)

• Allergy to povidone –iodine solution

• Hypotension /Syncope (vaso-vagal) / convulsions / death
• Perforation of eye ball / damage to orbital structures
• Retro-bulbar hemorrhage
• Optic nerve damage
COMPLICATIONS-INTRAOPERATIVE

• Sub-conjunctival hemorrhage • Falling of nucleus / pieces in

• Corneal burn
• Iris trauma
• Irido-dialysis
• Extension of capsular tear
• Posterior capsular rupture
vitreous
• Falling of IOL into the vitreous
• Supra-choroidal hemorrhage
EARLY POST OPERATIVE
• Striate keratitis
• Sub-conjunctival hemorrhage
• Retained lens matter
• Raised IOP
• Wound leak and iris prolapose
• Decentered IOL
• Hyphema
• Acute bacterial Endophthalmitis
• CMO
• Wound leak
• High astigmatism
• Wrong powered IOL
LATE
• Suture related complications
• PCO
• Pupillary lens capture
• Vitreous loss related complications (endothelial decompensation, CMO,
persistent uveitis, UGH syndrome, wick syndrome, RD, Glaucoma)
• Epithelial ingrowth
• Glaucoma
• Retinal detachment
• Chronic endophthalmitis
DISPLACEMENT OF THE LENS
•
Etiology

Ocular
• Injury
• bubhthalmos
Hypermture cataract

• Systemic
• Marfan’s syndrome
• Marchesani’s syndrome
• Homocystinuria
• Ehlers-Danlos syndrome