Summary

Cataract surgery is one of the most common and effective surgical procedures performed globally. It involves removal of the cataract and replacing it with an intraocular lens (IOL), with the aim of improving vision.

Indications for surgery

Surgery is indicated in any type of cataract if the symptoms from the cataract interfere with daily function. Age is not a contraindication to cataract surgery; improvements in vision often have significant benefits for older adults.

Surgical techniques

Cataract surgery is typically performed on an outpatient basis under local anaesthesia with monitored sedation. The local anaesthesia is supplied topically, by block or by sub-Tenon’s (episcleral) infusion. It is a quick surgery, with the intraocular components usually taking 10-20 minutes (by experienced surgeons).

The two techniques most commonly performed are:

• Small incision surgery (aka phacoemulsification)
• Standard extracapsular cataract extraction (ECCE)

Small incision surgery

This is the most commonly performed technique. It involves phacoemulsification of the lens (the steps of which are described below) and implantation of a synthetic intraocular lens.

Extracapsular cataract extraction (ECCE)

In ECCE, the anterior capsule and lens are removed through a large incision, but the posterior capsule is left in the eye. The surgery involves:

• Anterior capsulotomy
• Removal of lens nucleus and cortical contents: the lens nucleus is removed in one piece through the large incision; the cortex is aspirated; and the lens capsule left behind to support an IOL
• IOL placed in the eye and incision sutured

Extracapsular cataract extraction (ECCE).

Intracapsular cataract extraction (ICCE)