Cataract surgery

1. FAIZAL.M
ROLL.34

2. WHAT IS CATARACT?
The term cataract refers to development of any
opacity in the lens or its capsule
Cataract may occur, either due to formation of
opaque lens fibres or due to degenerative process
leading to opacification of the normally formed
transparent lens fibres

3. CLASSIFICATION
CATARACT
Etiological
Congenital and
developmental
Acquired
Morphological
1.Capsular
2.Sub capsular
3.Cortical
4.Nuclear
5.polar

4. CATARACT SURGERIES
1.ICCE-Intra capsular cataract extraction
The whole lens with capsule is removed
2.ECCE technique based surgeries :
a) conventional ECCE
b)SICS:small incision cataract surgery
c) phacoemulsification
d)FLACS:femtosecond laserassisted cataract
surgery

5. CONVENTIONAL ECCE
SURGICAL STEPS OF CONVENTIONAL ECCE
1.SUPERIOR RECTUS SUTURE(BRIDLE SUTURE)
is passed to fix the eye ball in downward gaze
2.CONJUCTIVAL FLAP(fornix based):-
To expose the limbus
3.PARTIAL THICKNESS GROOVE is made
through about two-third depth of anterior limbal
area from 10 to 2 O’clock postion with the help of a
razor blade knife

7. 4.Entry into anterior chamber-
The anterior chamber is entered with the
razor blade knife or with 3.2mm keratome
5.Injection of viscoelastic substance in
anterior chamber.(like 2% methylcellulose or l % sodium
hyaluronate )-This maintains the anterior chamber and
protects the endothelium

8. 6.ANTERIOR CAPSULOTOMY
Can be performed by any of the following:
a) Can-opener's technique:-an irrigating cystitome or
simply a 26-gauge needle, bent at its tipis introduced into
the anterior chamber and multiple small radial cuts are
made in the anterior capsule for 360°

9. b)Linear casulotomy(Envelope technique)
a straight incision is made in the anterior capsule
(in the upper part) from 2-10 O'clock position
c) Continuous circular capsulorrhexis (CCC):-anterior
capsule is torn in a circular fashion eilher with the help
of an irrigating bent- needle cystitome or with a
capsulorrhexis forceps

10. 7. Removal of anterior capsule:It is
removed with the help of a Kelman-
McPherson forceps

11. 8. Completion of corneascleral section. It is completed
from 10 to 2 O'clock position either with the help of
corneoscleral section enlarging scissors or 5.2 mm blunt
keratome

12. 9. Hydrodissection:- balanced salt solution
(BSS) is injected under the peripheral part of the anterior
capsule. This manoeuvre separates the corticonuclear mass
from the capsule
10.Removal of nucleus:-by the
following technique
a)Pressure and counterpressure method:-
posterior pressure is applied at 12 O'clock position with
corneal forceps or lens spatula and the nucleus is expressed
out by counterpressure exerted at 6 O'clock position with a
lens hook

13. b)irrigating wire vectis technique:loop of an
irrigating wire vectis is gently passed below tl1e
nucleus

14. I l. Aspiration of the cortex.
remaining cortex is aspirated out using a two-way
irrigation and aspiration cannula

15. 12. Implantation of IOL: The PMMA
posterior chamber lOL is implanted
in the capsular bag

16. 13. Closure of the incision is done by a
total of 3 to 5 interrupted or continuous sutures
14. Removal of viscoelastic
substance. Before tying the last suture the
viscoelastic material is aspirated out with 2 way cannula and
anterior chamber is filled will BSS.
15. Conjunctival flap is reposited

17. 16. Subconjunctival injection of
dexamethasone 0.25 mL and gentamicin 0.5 mL is given.
17. Patching of eye is done with a pad and
sticking plaster or a bandage is applied.

18. THANK YOU