The document describes three cataract extraction techniques: intracapsular cataract extraction (ICCE), extracapsular cataract extraction (ECCE), and manual small incision cataract surgery (SICS). ICCE involves removing the entire lens and capsule, while ECCE removes most of the lens leaving the posterior capsule. SICS performs ECCE through a small, sutureless incision. The document then details the steps for ECCE and SICS, and explains that phacoemulsification differs by using a smaller incision, continuous curvilinear capsulorrhexis, hydrodissection, and emulsifying/aspirating the nucleus with phacoemulsification before removing cortex

2. • Conventional extracapsular cataract extraction (ECCE),
• Manual small incision cataract surgery (SICS),
• Phacoemulsification
CONTENTS

3. • In this technique, the entire cataractous lens along with the intact capsule is
removed.
• Weak and degenerated zonules are a pre-requisite for this method.
• Because of this reason, this technique cannot be employed in younger
patients where zonules are strong.
• ICCE can be performed between 40-50 years of age by use of the enzyme
alpha- chymotrypsin (which will dissolve the zonules).
• Beyond 50 years of age usually there is no need of this enzyme.
Indications: It has been almost entirely replaced by planned extracapsular
technique. At present the only indications of ICCE is markedly subluxated and
dislocated lens.

4. 1. Superior rectus (bridle) suture
2. Conjunctival flap
3. Partial thickness groove or gutter
4. Corneoscleral section.
5. Iridectomy
6. Methods of lens delivery:
i. Indian smith method
ii. Cryoextraction
iii. Capsule forceps method.
iv.Irisophake method.
v. Wire vectis method.

5. 7. Formation of anterior chamber.
8. Implantation of anterior chamber (ACIOL)
9. Closure of incision
10. Conjunctival flap is reposited and secured by wet-field cauery.
11. Subconjunctival injection of dexamethasone 0.25 ml and
gentamicin 0.5 ml is given.
12. Patching of eye is done with a pad and sticking plaster or a
bandage is applied.

7. • In this technique, major portion of anterior capsule with epithelium,
nucleus and cortex are removed; leaving behind intact posterior
capsule.
• Indications: Presently, extracapsular cataract extraction
technique is the surgery of choice for almost all types of adulthood
as well as childhood cataracts unless contraindicated.
• Contraindications:The only absolute contraindication for ECCE
is markedly subluxated or dislocated lens.

8. 1. Superior rectus (bridle) suture
2. Conjunctival flap
3. Partial thickness groove or gutter
4. Corneoscleral section.
5. Injection of viscoelastic substance in anterior chamber.
6. Anterior capsulotomy methods:
i. Can-opener's technique.
ii. Linear capsulotomy (Envelope technique).
iii. Continuous circular capsulorrhexis (CCC).
7. Removal of anterior capsule.
8. Completion of corneoscleral section.

9. 9. Hydrodissection.
10. Removal of nucleus-techniques:
i. Pressure and counter-pressure method.
ii. Irrigating wire vectis technique.
11. Aspiration of the cortex.
12. Implantation of IOL.
13. Closure of the incision
14. Removal of viscoelastic substance.
15. Conjunctival flap is reposited and secured by wet field cautery.
16. Subconjunctival injection of dexamethasone and gentamicin.
17. Patching of eye is done with a pad and sticking plaster .

11. • Manual small incision cataract surgery (SICS) is becoming very
popular because of its merits over conventional ECCE as well as
phacoemulsification technique.
• In this technique ECCE with intraocular lens implantation is
performed through a sutureless self-sealing valvular sclero-
corneo tunnel incision.

12. 1. Superior rectus (bridle) suture
2. Conjunctival flap and exposure of sclera
3. Haemostasis
4. Sclero-corneal tunnel incision.
i. External scleral incision.
ii. Sclero-corneal tunnel.
iii. Internal corneal incision.
5. Side-port entry
6. Anterior capsulotomy.
7. Hydrodissection.

13. 8. Nuclear management.
i. Prolapse of nucleus
ii. Delivery of the nucleus
9. Aspiration of cortex.
10. IOL implantation.
11. Removal of viscoelastic material.
12. Wound closure.

15. It is presently the most popular method of extracapsular cataract
extraction. It differs from the conventional ECCE and manual SICS
as follows:
1. Side port entry
2. Corneoscleral incision required is very small (3 mm). Therefore,
sutureless surgery is possible with self-sealing scleral tunnel or clear
corneal incision made with a 3 mm keratome.
3. Continuous curvilinear capsulorrhexis (CCC) of 4-6 mm is
preferred over other methods of anterior capsulotomy.
4. Hydrodissection i.e., separation of capsule from the cortex by
injecting fluid exactly between the two is must for phacoemulsification
in SICS.

16. 5. Nucleus Removal: Nucleotomy is performed,Nucleus is
emulsified and aspirated by phacoemulsifier.
• Three commonly used techniques of nucleotomy are
a. ‘divide and conquer technique’,
b. ‘stop and chop’ and
c. ‘phaco chop technique’.
6. Remaining cortical lens matter is aspirated with the help of an
irrigation-aspiration technique.
7. Next steps i.e., IOL implantation, removal of viscoelastic
substance and wound closure are similar to that of SICS. Foldable
IOL is most ideal with phacoemulsification technique.