Intracapsular surgery

With this approach, a surgeon removes the entire lens—the capsule, the cortex, and the nucleus. The procedure is rarely performed today but is used in some situations—for instance, when the lens is partially or completely dislocated.

The surgeon makes an incision at the side of the cornea and then inserts a cryoprobe (a rod with an extremely cold tip) through the incision. When the tip of the probe touches the lens, the lens adheres to the probe—as a tongue might stick to a cold metal object in the winter—and the surgeon guides the lens out of the eye as the probe is withdrawn. The incision is closed with multiple fine sutures or a gel sealant.

Extracapsular surgery

This type of surgery became popular when surgeons realized that it minimizes trauma to the eye and is associated with fewer postoperative complications than intracapsular surgery. With this approach, the surgeon makes an incision at the side of the cornea and removes the front of the lens capsule, followed by the nucleus and the cortex. The back of the lens capsule remains intact and provides support for the lens implant. Most extracapsular surgery is performed using phacoemulsification.

Phacoemulsification

This is the most commonly used technique for cataract surgery. As with the traditional extracapsular procedure, the surgeon makes an incision at the outer edge of the cornea and inserts an instrument to remove the front of the lens capsule. However, instead of using standard surgical tools to remove the cataract, the surgeon inserts a thin probe. Once activated, the probe emits ultrasonic vibrations that break the cortex and nucleus of the lens into tiny fragments, which are vacuumed away through a thin tube. At this point, a lens implant can be inserted to replace the missing lens.

The major advantage of phacoemulsification is that the smaller surgical incision speeds postoperative healing. Recovery time can be further reduced when phacoemulsification is used in conjunction with a foldable intraocular lens implant, which is inserted and then unfurled inside the eye. When these techniques are used in combination, the incision can be as small as 2 or 3 mm—so small that often stitches are not needed.

Publication Review By: Susan B. Bressler, M.D., Harry A. Quigley, M.D., Oliver D. Schein, M.D., M.P.H.

Published: 28 Feb 2011

Last Modified: 03 Sep 2015