A cataract is the clouding of the usually transparent lens of the eye.

There is no other cure for it other than surgery.

As per Westbocaeyecenter, over 3.8 million procedures are carried out annually in the US.

There are three types of Cataract surgeries, Phacoemulsification, Extracapsular Cataract Extraction (ECCE) and Femtosecond Laser-assisted Cataract Surgery (FLACS).

Extracapsular Cataract Extraction (ECCE) is an eye surgery in which the eye’s lens is removed and replaced with an artificial lens.

The elastic capsule covering the lens is left partially attached to allow the implantation of an intraocular lens (IOL).

In this article, you will learn more about the types of ECCE, its preparation, and aftercare.

Types of Extracapsular Cataract Extraction

There are two types of ECCE. Depending on the severity of your condition, your doctor will determine the best surgery for you: 

Old woman with Cataract Surgery
Cataract Surgery

Conventional ECCE

Conventional or standard ECCE is less risky for people with very hard cataracts or weak epithelial tissue in the cornea.

The ultrasound vibrations used in Phacoemulsification strain the cornea.

A standard extracapsular cataract extraction takes less than an hour to complete. 

After cleansing the area around the eye with antiseptic, sterile drapes cover most of the face. 

A local anesthetic is used for the tissues around the eye. A topical anesthetic is used to numb the eye. 

An eyelid holder holds the eye open during the procedure. The doctor may administer an intravenous sedative if the patient is extremely nervous.

Your surgeon will create an incision where the sclera and cornea meet.  

This is done once the anesthetic has taken effect. 

A standard ECCE incision was typically 10-12 mm long in the 1970s. 

But the development of foldable acrylic IOLs has allowed many surgeons to work with incisions as short as 5-6 mm. 

This variation is also known as small-incision ECCE. 

Following the incision, the surgeon will create a circular tear in the front of the lens capsule. This process is known as Capsulorhexis.

The surgeon will carefully open the lens capsule and remove the hard nucleus of the lens using special instruments to apply pressure. 

Suction is used to remove the softer cortex of the lens after the nucleus has been expressed.

A special viscoelastic material is injected to help the empty lens capsule retain its shape. At the same time, the surgeon inserts the artificial lens. 

After the lens has been placed in the correct position, the viscoelastic substance is removed.

The incision is repaired with two or three sutures.

Phacoemulsification

In this surgery, the surgeon uses an ultrasonic probe. It is inserted through the incision to break up the core of the lens into smaller pieces.

The newer technique has the advantage of a smaller incision than standard ECCE. 

Few or no stitches are required to close the incision, and a shorter patient recovery time. 

What are the benefits of ECCE

There are various benefits of this surgery.

“With extracapsular extraction, however, there’s very little cost other than the fluid and some tubing. Even the cortical cleanup can be done with a manual device. In a humanitarian aid setting, extracapsular extraction is a much better solution.” 

George G. Ulrich, MD

Here are some other advantages of having this procedure for removing cataracts:

  • Faster recovery time than with traditional intraocular lens implantation
  • Reduced risk of infection and other complications
  • Less tissue trauma during surgery
  • The ability to adjust the lens power for better vision
  • Reduced risk of astigmatism compared to traditional IOL implantation
  • Long-term stability and clarity of vision
  • Fewer postoperative visits required

Preparation

ECCE is almost always elective surgery. 

It is only performed when the cataract leads to Glaucoma or the eye is severely injured or infected.

After the surgery has been scheduled, you may need to go through a test known as Keratometry if an artificial lens needs to be placed.

Painless testing is performed to determine the strength of the IOL required. 

Your ophthalmologist will use ultrasound to measure the length of your eyeball and a keratometer to measure the cornea’s curvature. 

The keratometer measurements are entered into a computer, which calculates the correct power for the artificial Complicationslens.

The IOL is a replacement for the lens in the eye. It is not a corrective lens.

Suppose you wear glasses or contact lenses before developing a cataract. In that case, you will still require them after the lens is implanted. 

Also Read: A variety of lenses are used in a Cataract surgery. Read about them in our article Types of Lenses for Cataract Surgery: A Comprehensive Guide.

Warning
The lens prescription should be checked after surgery because it will likely need to be adjusted.

Aftercare

types of cataract surgery
Cataract Surgery

You may use your eyes after the procedure but should have a friend or relative drive you home. 

Before you leave the clinic, your doctor may inject some medications, usually steroids, and antibiotics, into the operated eye. 

They might also give you aftercare tips following Cataract surgery for a quicker healing process and to avoid complications.

You may return to work the following day, though the eye will take three weeks to three months to heal completely. 

You can resume normal activities within one to two days of surgery, except for heavy lifting or extreme bending. 

The doctor may advise you to wear their glasses during the day and to tape an eye shield over the eye at night. 

On bright days, wear sunglasses and avoid rubbing or bumping the operated eye.

In addition, the ophthalmologist will prescribe anti-inflammatory eye drops for one to two weeks to prevent infection, manage pain, and reduce swelling.

It would help if you used these eye drops as directed.

In the weeks following ECCE, you might be scheduled for frequent checkups.

Your doctor may check your eye the day after surgery and then once a week for several weeks.

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Complications

Approximately 25% of patients with a cataract removed using either extracapsular method will eventually develop clouding in the lens capsule left to hold the new IOL.

This clouding, or Posterior Capsular Opacification (PCO), is not a cataract but can still impair vision. 

PCO is caused by the growth of epithelial cells left behind after removing the lens. 

Good to know
PCO is treated with Capsulotomy, a procedure in which the doctor uses a laser to cut through the clouded part of the capsule.

Some other risks of ECCE are:

  • A rise in intraocular pressure (IOP)
  • Edema 
  • Uveitis
  • Infection
  • Hyphema
  • Leaking or rupture of the incision
  • Retinal detachment or tear
  • Malpositioning of the IOL
  • Cystoid macular edema (CME)

Conclusion

Cataract surgery is a surgical procedure that removes your eye’s lens and, in most cases, replaces it with an artificial lens.

There are three types of Cataract surgeries, Extracapsular Cataract Extraction being one of them.

Extracapsular Cataract Extraction (ECCE) is an eye surgery in which the lens is removed and replaced with an artificial lens.

It offers several advantages, including a shorter recovery time and a lower risk of complications. 

Extracapsular cataract extraction may be an ideal choice if you are looking for a safe and effective way to treat Cataracts.

Frequently Asked Questions

How is Extracapsular Cataract Extraction performed?

The term ECCE refers to a technique in which a portion of the lens’s anterior capsule is removed, allowing the lens nucleus and cortex to be extracted while leaving the remainder of the anterior capsule, posterior capsule, and zonular support intact.

What are the three types of Cataract surgery?

There are three types of Cataract surgeries, Phacoemulsification, Extracapsular Cataract Extraction (ECCE) and Femtosecond Laser-assisted Cataract Surgery (FLACS).

What are the complications of Extracapsular Cataract Extraction?

Extracapsular Cataract Extraction (ECCE) can have complications such as Posterior Capsular Opacification, Edema, Uveitis, Infection, and Hyphema. Some other risks are leaking or rupture of the incision, retinal detachment or tear, and Cystoid macular edema (CME).

What is the most common cataract surgery?

As per John Hopkins Medicine, Phacoemulsification is the most common type of cataract removal. The eye surgeon makes a tiny opening in the eye next to the outer corner. A small probe gives off ultrasound waves to dissolve the core, the hard part of the cloudy lens.

Citations:
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