1. Comparison of various cataract surgical techniques Dr. AnandSudhalkar, Baroda 2/19/2010 Sudhalkar Eye Hospital and Retinal Laser Centre, Baroda 1

2. Why Cataract Surgery Medical management: Lengthy, costly, inefficient, Surgery: quick, immediately rewarding, most efficient amongst all surgeries, Justified Aim: To clear visual axis 2/19/2010 Sudhalkar Eye Hospital and Retinal Laser Centre, Baroda 2

3. Couching ( Ancient) No anaesthesia Fastest? Displace the lens: (Morgagnian) Clears Visual Axis, Instant vision Break the capsule (needling) Delayed complications: Inflammation. 2/19/2010 Sudhalkar Eye Hospital and Retinal Laser Centre, Baroda 3

4. Extracap AC wash Topical Cocain (<1950) Technique Break Anterior capsule Deliver the nucleus Reposit the wound, no sutures Strict bedrest, bilat patching, sandbags. Let the nature take over Concerns High failure rate/ ambulatory vision Iris prolapse Phacoanaphylactic reactions After cataracts 2/19/2010 Sudhalkar Eye Hospital and Retinal Laser Centre, Baroda 4

5. Intracap (1960-1982): Retrobulbar Technique Removing the lens with intact capsule : Clear media Holding anterior capsule: Forceps, Erisiphake, Cryo Zonulysis: Chymotripsin Keeping intact hyaloid phase PBI, Suturing VL, Vit. Vick, Choroidal detach, RD, CME Aphakia The Instrument 2/19/2010 Sudhalkar Eye Hospital and Retinal Laser Centre, Baroda 5 Intra forceps, cryo

6. Aphakia 2/19/2010 Sudhalkar Eye Hospital and Retinal Laser Centre, Baroda 6

7. Intracap + Ac IOL ( 1982-1984) Retrobulbar Technique Introduction to Microsurgery 10/0 suturing Viscoelastic Concept of anterior vitrectomy AC IOL 2/19/2010 Sudhalkar Eye Hospital and Retinal Laser Centre, Baroda 7

8. Extracap + PC IOL (1982-1992) Retro/Peribulbar Technique Microsurgery Precise ant. Cap. Smooth Nucleus delivery Irrigation aspiration concept of AC maintenance. Thorough cortical cleanup Simcoe canula Posterior Chamber IOL 2/19/2010 Sudhalkar Eye Hospital and Retinal Laser Centre, Baroda 8

9. Phaco + Rigid IOL (1992 – 2000) Peribulbar Technique Small Incision/Less Astigmatism Rhexis Visco Chamber stability Precision in nucleus management In the bag implantation 2/19/2010 Sudhalkar Eye Hospital and Retinal Laser Centre, Baroda 9

10. Phaco + Foldables (2000 onwards) Peribulbar/Topical 2/19/2010 Sudhalkar Eye Hospital and Retinal Laser Centre, Baroda 10

11. The pearls Past Techniques Couching ECCE/Needling Intracap ECCE + PC IOL Present Applications Consider correcting aphakic zone, AC IOL Infants, Bilat Cataract Hypermatsubluxated cataracts Hard Cataracts, Machine failures, compromised corneas, Shallow AC, Small pupils, Synechias 2/19/2010 Sudhalkar Eye Hospital and Retinal Laser Centre, Baroda 11

12. The message 2/19/2010 Sudhalkar Eye Hospital and Retinal Laser Centre, Baroda 12 Take each case on its merit and be prepared for modifications The choice of a technique should be surgeon’s discretion and should not be offered as “goods” on display Thank You