Types of Cataract surgeries.pptx

Catract

1. Types of Cataract Surgeries

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

3. INTRACAPSULAR CATARACT EXTRACTION 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. Surgical steps of the ICCE technique 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.

6. CONVENTIONAL EXTRACAPSULAR CATARACT EXTRACTION 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.

7. Surgical steps of conventional ECCE 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.

8. 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 .

9. MANUAL SMALL INCISION CATARACT SURGERY 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.

10. Surgical steps of manual SICS : 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.

11. 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.

12. PHACOEMULSIFICATION 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.

13. 5. Nucleus Removal: Nucleotomy is performed, Nucleus is emulsified and aspirated by phacoemulsifier. Three commonly used techniques of nucleotomy are ‘divide and conquer technique’, ‘stop and chop’ and ‘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.

14. THANK YOU