Intracapsular Cataract extraction

Details about ICCE

1. INTRACAPSULAR CATARACT EXTRACTION By: Jeslin Jose

2. Intracapsular Cataract E xtraction In this technique the entire cataractous lens including the intact capsule is removed by rupturing the zonules . Therefore weak and degenerated zonules are a pre-requisite for this method. This technique is becoming obsolete and sparingly used worldwide. It has been widely employed for about 100 years before the advent of the modern technologies and is an important landmark in the history of cataract surgery. Now it has been replaced by planned extracapsular techniques.

3. INDICATION: Immature cataract Hypermature cataract Cataract in stage of intumescent Complicated cataract due to iridocyclitis to avoid lens induced iritis which may occur in extracapsular cataract extraction Diabetic patients Cataract associated with glaucoma Dislocation of lens An eye with degeneration of vitreous. Note: At present only indication of ICCE is markedly subluxated and dislocated lens.

4. INTUMESCENT CATARACT HYPERMATURE CATARACT

5. CONTRAINDICATION Patients with systemic disease like asthma, cough, dyspnea and cardiac problem. Patients with an excess of orbital fat. Brown cataract Any complication after section of cornea which may result in failure of ICCE. P atients below 40 years of age cannot be performed Posterior chamber IOL cannot be implanted

6. Asthma patients Patient with cough Patient with cardiac problem Patient with excess orbital fat Brown cataract Posterior chamber IOL

7. Instrumentation: Lid screw clamps Eye speculum Conjunctival fixation forceps Von Graefe’s knife or diamond knife Keratome

8. Instrumentation: C orneal scissors Iris forceps Iris repositer Intracapsular forceps Lens expressor

9. Iridectomy scissors Syringe with irrigation canula Fine tooth forceps Plain suture forceps Blade no. 15 and handle

10. Artery forceps Bipolar electric cautery Cryo unit Erisophake Needle holder

11. ANESTHESIA General anesthesia for children and apprehensive patients. In most cases the surgery can be performed with local anesthesia.

12. General preparation I n addition to general preparation and positioning, a small rolled towel or blanket may be placed under the patient’s shoulder to hyperextend the neck. The OT positions the operating microscope and it is adjusted for focus. The microscope is then locked into position and rotated away from the field to allow for prepping and draping. The eye prep extends fron the hairline to mouth and from nose to ear.

13. SURGICAL STEPS

14. Passing of superior rectus suture Fornix based conjunctival flap Partial thickness groove

15. SURGICAL STEPS

16. Completion of corneo -scleral section Peripheral Iridectomy

17. i. Smith indian method: Here the lens is delivered with tumbling technique by applying pressure on limbus at 6 O’clock position with lens expressor and counterpressure at 12 O’clock with the lens spatula. With this method lower pole is delivered first. ii.Cryoextraction. Lens surface dried with a swab, retracted up and tip of cryoprobe is applied on the anterior surface of the lens in the upper quadrant. Freezing is activated(-40°C) to create adhesions between the lens and the probe. The zonules are ruptured by gentle rotatory movements and the lens is then extracted out by sliding movements. In this technique, upper pole of lens is delivered first.

18. iii. Capsule forceps method. The Arruga’s capsule holding forceps is introduced close into the anterior chamber and the anterior capsule of lens is caught at 6 O’clock position. The lens is lifted slightly and its zonules are ruptured by gentle sideways movemnets . Then the lens is extracted with gentle sliding movements by the forceps assisted by a pressure at 6 O’clock position on the limbus by the lens expressor . iv. Irisophake method. This technique is obsolete and thus not in much use v. Wire vectis method. It is employed in cases with subluxated or dislocated lens only. In this method, the loop of the wire vectis is slide gently below the subluxated lens, which is then lifted out of the eye.

19. Cryolens Extraction Insertion of Kelman multiflex intraocular lensin anterior chamber Corneo -scleral suturing

20. POSTOPERATIVE TREATMENT Make the patient ambulatory after 12 hours when he is out of sedation effect. Remove the dressing and start instillation of antibiotic and steroid eye drops four times a day i.e. after 24 hours. Discharge the patient with advise to lead a sedentary normal life for few days. He is advised to take a light diet but rich in proteins. Remove stitches after one month and the prescribe glasses. He can make use of green goggles to avoid glare.

21. Dressed eye Remove dressing from eye Green goggles

22. POSTOPERATIVE COMPLICATIONS Striate keratopathy Shallow anterior chamber Cystoid macular edema Detachment of choroid Secondary glaucoma Iritis Herniation of vitreous in the anterior chamber.

23. Striate keratopathy Secondary glaucoma with lens disorders Cystoid macular edema Choroidal detachment

24. RESULTS The results are 100% with advent of operating microscope and microsurgery instruments and better care of patient. Operating microscope Microsurgical instruments Better care of patients

25. Comprehensive ophthalmology by A.K.Khurana . Ch-9 & Pg no. 198, 199-201, 210 2. Ophthalmic surgical assisting by Bernice Jackson Williams. Ch-13 & Pg No.94 Ophthalmology for undergraduate students by M.L. Agarwal, L.C.Gupta and Sanjeev Agarwal. Ch - 27& P g no.497-499 References