INTRACAPSULAR CATARACT EXTRACTION

Presently, the technique of intracapsular cataract
extraction (ICCE) is obsolete and sparingly performed
world wide. However, the surgical steps are described
in detail as a mark of respect to the technique which
has been widely employed for about 50 years over
the world and also to care for the emotions of few
elderly surgeons who are still performing this
operation (though unethical) at some places in
developing countries.
Surgical steps of the ICCE technique are as follows:
1. Superior rectus (bridle) suture is passed to fix the
eye in downward gaze (Fig. 8.17A).
2. Conjunctival flap (fornix based) is prepared to
expose the limbus (Fig. 8.17B) and haemostasis is
achieved by wet field or heat cautery. All surgeons
do not make conjunctival flap.
3. Partial thickness groove or gutter is made through
about two-thirds depth of anterior limbal area from
9.30 to 2.30 O'clock (150o) with the help of a razor
blade knife (Fig. 8.17C).
4. Corneoscleral section. The anterior chamber is
opened with the razor blade knife or with 3.2mm
keratome (Fig. 8.17D).
5. Iridectomy (Fig. 8.17E). A peripheral iridectomy
may be performed by using iris forceps and de
Wecker's scissors to prevent postoperative pupil
block glaucoma.
6. Methods of lens delivery. In ICCE the lens can be
delivered by any of the following methods:
i. Indian smith 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. In this technique, cornea is lifted
up, lens surface is dried with a swab, iris is
retracted up and tip of the cryoprobe is applied
on the anterior surface of the lens in the upper
quadrant. Freezing is activated (–40oC) 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 the lens is delivered first (Fig. 8.17F).
iii. Capsule forceps method. The Arruga's capsule
holding forceps is introduced close into the
anterior chamber and the anterior capsule of the
lens is caught at 6 O'clock position. The lens is
lifted slightly and its zonules are ruptured by
gentle sideways movements. 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.
7. Formation of anterior chamber. After the delivery
of lens, iris is reposited into the anterior chamber with
the help of iris repositor and chamber is formed by
injecting sterile air or balanced salt solution.
8. Implantation of anterior chamber (ACIOL) (Figs.
8.17 G & H). For details see page 197.
9. Closure of incision is done with 5 to 7 interrupted
sutures (8-0, 9-0 or 10-0 nylon) (Fig. 8.17I).
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.