Not all cataract surgeries are the same. Depending on the severity of the cataract, the health of the eye, and the patient’s needs, ophthalmologists choose from three main surgical techniques. Each method has its benefits and is suited for different cases. As a cataract surgeon from London we’ll explore these three types of cataract surgery in detail, helping you understand how they work and what to expect if you or a loved one are preparing for treatment.
Phacoemulsification: The Most Common Procedure
Phacoemulsification, often referred to as phaco surgery, is the most widely used cataract removal technique today. It is a minimally invasive procedure that offers quick recovery and excellent visual outcomes.
The surgery involves making a tiny incision in the cornea, usually around 2 millimeters in size. Through this incision, an ultrasonic probe is inserted into the eye to break up the cloudy lens into small fragments using high-frequency sound waves. Once the lens has been emulsified, the surgeon removes the fragments through suction, leaving the natural lens capsule intact.
After the cataract is removed, an artificial intraocular lens (IOL) is implanted to restore clear vision. The small incision usually heals without stitches, and most patients experience improved sight within a few days to a week.
Why Is Phacoemulsification the Preferred Choice?
- Minimally invasive with a small incision size
- Quick recovery, often within days
- Low complication rate
- Suitable for most cataract cases.
Patients undergoing phacoemulsification usually have a local anaesthetic, meaning they remain awake but feel no pain. The procedure is completed in about 15 to 20 minutes, and patients can return home the same day.
Extracapsular Cataract Extraction (ECCE): When a Larger Incision Is Needed
Extracapsular Cataract Extraction (ECCE) is a technique used when cataracts are too dense or too advanced to be broken up using ultrasound, making phacoemulsification impractical. This method requires a larger incision so the cloudy lens can be removed in one piece.
During ECCE, the surgeon makes a 10 to 12 millimeter incision in the cornea or sclera (the white part of the eye). Unlike phacoemulsification, where the lens is broken down inside the eye, ECCE involves manually removing the lens while leaving the back part of the capsule intact to support the new IOL.
Because the incision is larger, stitches are often required, and the recovery time is longer compared to phaco surgery. Patients may need several weeks to regain full visual clarity and must be cautious to avoid activities that could put pressure on the healing eye.
When Is ECCE Used?
- For very dense cataracts that cannot be broken down by ultrasound
- In cases where phacoemulsification is not suitable, such as complications from previous surgeries
- In settings where advanced phaco equipment is unavailable, remote areas of the world
While ECCE is not as common as phacoemulsification, it remains an important option for patients with mature cataracts who require a more manual approach to lens removal.
Intracapsular Cataract Extraction (ICCE): The Least Common Approach
Intracapsular Cataract Extraction (ICCE) is an older technique that is rarely used today due to its higher risk of complications. However, in specific cases, it remains a viable option.
ICCE involves removing both the lens and its surrounding capsule in one complete piece. This requires a very large incision and exposes the inside of the eye to potential infections and complications. Because of these risks, ICCE is now mostly reserved for unique medical conditions where other techniques are not possible.
Patients who undergo ICCE typically require a special type of intraocular lens (IOL), which is placed in a different part of the eye compared to modern techniques. Recovery takes longer than both phacoemulsification and ECCE, and post-surgical care is more intensive.
Why Would ICCE Be Used Today?
- Severe trauma to the eye, where the lens is already displaced
- Extremely advanced cataracts, where the lens is unstable
- Limited access to modern surgical technology, often in remote areas
Although ICCE was the standard method decades ago, modern advancements have largely replaced it with safer, less invasive techniques.
Which Type of Cataract Surgery Is Right for You?
For most patients, phacoemulsification is the preferred option due to its quick recovery, minimal discomfort, and high success rate. However, in cases where cataracts are too dense or other factors are at play, ECCE or ICCE may be recommended.
Your eye surgeon will determine the best approach based on factors such as:
- The density and maturity of your cataracts
- The health of your eye and any previous surgeries
- Your overall health and risk factors
- The availability of advanced surgical equipment.
Regardless of the technique used, cataract surgery has a high success rate, and most patients regain clear vision within weeks of the procedure. Cataract healing time is also a variable that needs to be taken into consideration.
Restoring Vision
Cataract surgery has come a long way, offering patients safe and effective solutions for restoring vision. While phacoemulsification remains the gold standard, extracapsular extraction and intracapsular extraction are still important in specific situations. You may also be wondering if you need to wear glasses after cataract surgery?
If you’re considering cataract surgery, discussing your options with a qualified ophthalmologist will help you understand which method is best suited for your needs. With the right approach and proper aftercare, clearer vision is within reach.
