1. Extracapsular surgery for cataracts
The lens of the eye is enclosed in a lining called the lens capsule. Extracapsular surgery, also
called extracapsular cataract extraction (ECCE), involves removing the lens with the cataract
from the lens capsule. In most cases, the lens will be replaced with an intraocular lens implant
(IOL). If an IOL cannot be used, contact lenses or eyeglasses must be worn to compensate
for the lack of a natural lens.
Extra capsular surgery with or without phacoemulsification involves removing the lens as well
as the front portion of the lens capsule (anterior capsule). The back of the lens capsule
(posterior capsule) is left inside the eye to keep the vitreous gel in the back of the eye from
oozing forward through the pupil and causing complications.
Extracapsular surgery using phacoemulsification has become the most commonly used
procedure for cataract removal. This is a special type of extracapsular surgery that involves
removing the lens through the front portion of the lens capsule.
Extra capsular surgery without phacoemulsification involves: An 8 mm to 10 mm incision is
made in the eye where the clear, front covering of the eye (cornea) meets the white of the eye
(sclera). Another small incision is made into the front portion of the lens capsule, and the lens
is removed, along with any remaining lens material. An intraocular lens implant (IOL) may
then be placed inside the lens capsule, and the incision is closed.
Anesthesia
Most cataract surgery is now done using a topical anesthetic (eyedrops) or a local anesthetic.
Local anesthetic may involve a sedative for relaxation followed by an injection beside, under,
or inside the eye to deaden nerves and prevent blinking or eye movement during surgery.
General anesthetic may be necessary for: People with extreme anxiety that cannot be
controlled with simple sedation or counseling. People who are unable to follow instructions
during surgery. People who are allergic to certain local anesthetics. People with other medical
conditions that require the use of a general anesthetic. Children.
What to Expect After Surgery
Before you leave the outpatient center, you will receive the immediate eye care that is needed
after surgery. The surgeon reviews the symptoms of possible complications, eye protection,
activities, medications, required visits (see below), and what to do for emergency care if
needed. Portions of the follow-up may be done by another health professional, such as an
optometrist or community health nurse.
The eye that was operated on may be bandaged for one night after surgery. You will wear a
protective shield over the eye at night for about a week. There is normally no pain after
surgery.
You will usually need to see the doctor for checkups within 2 days after surgery, and after 1 to
4 weeks. Visits should occur sooner and more frequently if any complications occur.
Checkups following cataract surgery include:Ophthalmoscopy, to evaluate the inside of the
eye. Measurement of visual acquity and eye pressure (tonometry). A slit lamp exam, to check
for lens clarity.
Eyeglasses may be prescribed within 3 to 8 weeks after surgery. An average of 3 months is
required for healing after cataract surgery.
Contact your doctor promptly if you notice any signs of complications following cataract
surgery, such as:Decreasing vision. Increasing pain. Increasing redness. Swelling around the
eye. Any discharge from the eye. Any new floaters, flash of light, or changes in your field of
vision.

2. Why It Is Done
Cataract surgery may be done when:
Your work or lifestyle is affected by vision problems caused by the cataract. Glare
caused by bright lights is a problem. You cannot pass a vision test required for a driver's
license. You have double vision. The difference in vision between the two eyes is significant.
You have another vision-threatening eye disease, such as diabetic retinopathy or macular
degeneration.
Reasons not to have surgery (contraindications)
Cataract surgery will not be done if: You do not want surgery. Glasses or visual aids provide
adequate vision. Your lifestyle is not affected by the cataract. Surgery is not possible because
of another medical condition. You have vision loss that has been caused by another eye
disease. Removal of a cataract may not improve vision loss caused by another eye disease.
Extracapsular surgery using phacoemulsification may not be used if the cataract is too hard to
be broken up by sound waves (ultrasound).
How Well It Works
Cataract surgery has a 90% to 95% success rate in older adults whose only eye problem is
cataracts. Overall, an increase in well-being and quality of life can be expected after surgery
in 90% of all people who are bothered by their cataracts.1
Extracapsular surgery with or without phacoemulsification restores the same amount of
vision. However, recovery of sight occurs sooner after surgery with phacoemulsification.
People who have surgery for cataracts usually have:Improved vision. Increased mobility and
independence. Relief from the fear of going blind.
Surgery may also improve vision in infants who have cataracts.
Risks
Up to 3% of people have complications from cataract surgery that may threaten their sight or
require further surgery. The rate of complications increases in people who have other eye
diseases in addition to the cataract.1
Though the risk is low, surgery for cataracts does involve the risk of some vision loss if the
surgery is not successful or if there are complications. Potential complications that may occur
with cataract surgery include:Infection in the eye (endophthalmitis). Swelling and fluid in the
center of the nerve layer (cystoid macular edema). Swelling of the clear covering of the eye
(corneal edema). Bleeding in the front of the eye (hyphema). Bursting (rupture) of the capsule
and loss of fluid (vitreous gel) in the eye. Detachment of the nerve layer at the back of the eye
(retinal detachment).
Complications that may occur some time after surgery include:Problems with glare.
Dislocated intraocular lens. Clouding of the portion of the lens covering (capsule) that remains
after surgery, often called second membrane or aftercataract (posterior capsular
opacification). This is usually not a significant problem and can easily be treated with laser
surgery if necessary. Infants have the highest risk (almost 100%) for cloudiness in the back
portion of the lens capsule following cataract surgery. If posterior capsule opacification
develops after cataract surgery, a laser procedure or a vitrectomy that removes the posterior
capsule may be needed. Removing a small part of the posterior capsule during cataract
surgery may allow better sight and reduce the need for laser surgery. Lenses made of
polyacrylic material decrease the chance of posterior capsular opacification more than lenses
made of polymethyl methacrylate or silicone.2Retinal detachment. Glaucoma. Astigmatism or
strabismus. Sagging of the upper eyelid (ptosis).
What To Think About
Today, extracapsular surgery using phacoemulsification is used more often than standard
extracapsular surgery, even though they are similar procedures. The major difference is that

3. phacoemulsification uses sound waves (ultrasound) to break the lens into small pieces that
can then be removed through a smaller incision. In standard extracapsular surgery, the lens is
removed in one piece, which requires a larger incision. The improvement of vision is the same
for both procedures, but the healing process is quicker for phacoemulsification.
Removing cataracts by extracapsular surgery using phacoemulsification is preferred over
standard extracapsular surgery because: The surgery can be done more quickly. There is
less astigmatism after surgery. Recovery of sight after surgery is faster. The risk of
complications after surgery is less.
People usually need reading glasses (glasses for near vision) after cataract surgery.
However, some people may choose to have different lens implants in their eyes so that one
eye can be used for distance vision and the other for near vision (monovision). For more
information, see replacing the lens of the eye during cataract surgery.
Intraocular lens implants (IOLs) are available that allow you to see both distance and near
vision. However, these lens are usually not covered by insurance and may be very expensive.
In some children, surgery to remove a cataract that causes significant vision loss may be very
important in preventing blindness. The most critical period for the development of sight is from
birth to 6 months. The earlier cataracts in children are diagnosed and treated, the more likely
it is that their eyesight will be protected.
If a child has cataracts in both eyes that are causing significant vision loss, surgery on the
second eye needs to be done within a few weeks. As in adults, both eyes are not operated on
at the same time in case complications develop.
Surgeons are hesitant to put intraocular lenses (IOLs) in the eyes of infants younger than 1
year of age because of rapid eyeball growth and lack of information on the effect of IOLs in
these children.
Most often, an infant has to wear a contact lens to replace the lens that was removed from the
eye.
If surgery can be delayed until the child is 1 to 2 years old, it may be possible to use an IOL to
replace the lens in the eye. Surgery cannot always be delayed, however, because of the risk
of amblyopia and permanent vision loss.
Citations American Academy of Ophthalmology (2001). Cataract in the Adult Eye (Preferred
Practice Pattern). San Francisco: American Academy of Ophthalmology.Hollick EJ, et al.
(1999). The effect of polymethylmethacrylate, silicone, and polyacrylic intraocular lenses on
posterior capsular opacification 3 years after cataract surgery. Ophthalmology, 106(1): 49–54.