This document compares various cataract surgical techniques from ancient to modern times. It describes the evolution of techniques from couching and needling without anesthesia to current phacoemulsification with foldable intraocular lenses. Each new technique brought improvements such as more precise surgery, reduced complications, and less induced astigmatism. The latest techniques allow for small incisions, use of viscoelastic aids, chamber stability, and precision in nucleus management. The document encourages tailoring the surgical approach individually based on each case's specific merits rather than a one-size-fits-all method.

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