|Year : 1984 | Volume
| Issue : 6 | Page : 481-484
Extracapsular cataract surgery
Karnal Eye Institute, Dyal Singh College Road, Karnal, India
J K Pasricha
Karnal Eye Institute, Dyal Singh College Road, Karnal
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Pasricha J K. Extracapsular cataract surgery. Indian J Ophthalmol 1984;32:481-4
Extracapsular Cataract Extraction (ECE) as a routine surgery, is still a controversial subject. Logical reasons are being advanced in favour and against it . Keeping in view, the positive advantages of retained posterior capsular sheet, ECE is gaining popularity with surgeons. The obvious disadvantages of residual posterior capsular opacification, are being negated with improved surgical techniques .
| Materials and methods|| |
450 cases clinically fit for routine cataract surgery were included. Following operative steps were common for all cases
(a) Local Anaesthesia ; (retrobulbar, facial and topical)
(b) Mydriasis : (Atropine previous night; cyclamide and/or Drosyn every 15 minutes 6 times before surgery). 1 /3 ml of Adrenaline Hci 1 : 1000 sub-tenon injection at 6-`0' clock position on the table.
(c) 4-0 superior-rectus suture and lower lid suture.
(d) Fornix based conjunctival flap.
(e) Preplaced and 2 or 4 postplaced sutures and flap reposition.
(f) Normal Saline in A.C. to form chamber.
(g) Sub, conj. Gentamicin and Hydrocortisone.
Catg. A Corneo-scleral section
Gr.-I (316 cases) : 180° Corneal incision with cataract knife was given.
Gr. -II (134 cases) : Limbal section was made with a blade piece; half thickness gutter was first made in 180 degrees. Section enlarged only after anterior capsulectomy done through stab incision at 11-`0' clock.
Gr. -I Peripheral 170 cases
Gr. -I1 Broad 27 cases
Gr. -III No Iridectomy 123 cases
Broad Iridectomy was done in cases where pupil constricted on opening the A.C. and did not adequately dilate with adrenaline irrigation or in cases of very intumesent lens and in suspected narrow angle.
Catg.-C Anterior Capsulectomy
Gr. -I Open Skv Method and Routine Irrigation (316 cases)
Anterior capsulectomy done with specially designed No. 26 gauge hypodermic needle with its 1/2 mm tip bent at right angle and mounted on a tuberculin syringe; filled with normal saline. The needle was entered I l-`0' clock position. Anterior Capsulectomy was started at l2-`0' clock under direct view.
Circular sweep was given in clockwise fashion in single continuous sweep. Nucleus alongwith capsule and cortex was flushed out by normal saline irrigation. Height of the normal saline bottle was adjusted as per requirement usually 3/4th meter above the patient. The saline flow from the Canula was directed round the clock. Iris at 12-`0' clock was occasionally withdrawn with sponge. A-3 mm. A.C. irrigator with flushing holes all around mounted on 2 cc syringe filled with saline was used if the cortex cleaning was not satisfactory. An irrigating capsule forceps was used for pulling out loose remnants in anterior chamber. Slight aspiration with blunt tip canula was occasionally done with syringe. The Operating Microscope was used after irrigation of the A.C. and attempt was made to clean the cortical remnants as far as possible.
Gr. -II Closed Method with Vitreophage Aspiration Irrigation (134 cases)
In Catg. -A, Gr. II, Capsulectomy needle entered at 11-`0' clock position by giving a small stab incision. Saline was injected in bits to keep the Anterior Chamber formed. Irrigation aspiration was performed with Payman's Vitreophage on Nagpal's Vitrectomy unit. The controlled aspiration of the cortical matter was done carefully. All out attempts were made to keep the Posterior capsule pushed back by the flow of irrigating solution which was done by adjusting height of the infusion bottle. The aspiration irrigation procedure was performed under Operating Microscope. The cortical matter under the Iris was tackled by circulating the tip of the Vitreophage having a careful control.
Catg. -D Posterior Capsulotomy on the Table
Gr. -I (150 cases); No Capsulotomy was performed where red reflux was clear expecting good vision without capsulotomy. The cases with bulging Posterior capsule were also spared fearing vitreous loss (27 cases). The cases having rupture of the Posterior capsule during irrigation aspiration (4 cases); no posterior capsulotomy was necessary; instead anterior Open Sky Vitrectomy was performed after snipping Vitreo-fibral bands with Vanna's Scissor and aspirating the vitreous from the A.C.
Gr. II (170 cases) : Posterior capsulotomy on the table was done with Open Sky Method with capsulotomy needle entered at 12- `0' clock position and a vertical slit made in the posterior capsule from below upward. No Microscope was used in this group.
Gr. -I1I (130 Cases) : Capsulotomy with a specially designed 26 gauge hypodermic. needle curved on its beveled edge under the Operating Microscope. This procedure was adopted after tying 11 and 12-`0' clock sutures and filling the A.C. with Normal Saline.
| Observations|| |
Catg. -A Unsatisfactory wound healing was observed in 5 cases (1.6%) of Gr. -I i.e. knife section whereas Gr. -II section healing was very satisfactory and P.O. astigmatism comparatively less.
Catg. B Iridectomy seems to play no role since there was no difference in post-operative results in any of the 3 groups.
Catg. C A well formed anterior chamber and fully dilated pupil are very helpful pre-requisites in performing a good anterior capsulectomy. It is observed that cases including in Gr. -Il did very well since anterior capsulectomy was safe and very effective and the aspiration irrigation method adopted left clear and cleaner eyes as compared to Gr. -I in the same category. [Table - 1].
Reference [Table - 2] it is obvious that posterior capsulotomy on the table definitely reduces the need for discission at a later date. The incidence of anterior Vitreous face rupture was initially high but later on with experience and better maneuverability it became low.
| Discussion|| |
The advantages of retained post-capsular sheet cannot be underestimated. This barrier does prevent endophthalmodonesis and so all complications arising due to movement of vitreous are found to be less. This capsular sheet is quite an effective barrier from any bacterial or noxious chemicals, invading from the anterior to the posterior segment. Also, the late surgery in aphakic eye i.e. glaucoma, keratoplasty is easier and effective. Less incidence of vitreous loss, and its numerous attending complications is no smaller consideration. Posterior chamber intraocular lens implants, are certainly better than other & therefore, a good extracapsular cataract extraction is inevitably important. There is no denial that residual posterior capsular opacification, needing second surgery does involve ; added expense, anxiety, possible operative complications and unkind remarks from Surgeon colleagues. Also many retina surgeons are against ECE being adopted as routine. But post capsulotomy is immensely helpful when perfected.
| Summary|| |
450 Cataract cases were subjected to Routine Extra Capsular surgery. Comparative study was made as regards the type of corneal section; need " for iridectomy. method of Anterior Capsulectomy and aspiration irrigation techniques and also visual results were evaluated in cases having Posterior Capsulotomy on the table and those with No Capsulotomy.
| References|| |
Jaffe, N.S., 1981, "Cataract Surgery and its Complications", St, Louis, U.S.A. P. 70, 3rd Edition,
Blumenthal, M. and Yoram, S, 1983, Afro. Asi. J. Ophthalmol Vol. II, No. 1.
[Table - 1], [Table - 2]