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A extracapsular cataract is a painless, cloudy area in the lens of the eye. The lens is enclosed in a lining called the lens capsule. Cataract surgery separates the cataract from the lens capsule. In most cases, the lens will be replaced with an intraocular lens implant (IOL). If an IOL cannot be used, contact lenses or eyeglasses must be worn to compensate for the lack of a natural lens.
See a picture of the lens.
Phacoemulsification and extracapsular cataract extraction are surgical methods that remove the cataract as well as the front portion of the lens capsule (anterior capsule). The back of the lens capsule (posterior capsule) is left inside the eye to keep the vitreous gel in the back of the eye from oozing forward through the pupil and causing problems. The posterior capsule also supports the IOL and helps keep it in the proper position. These types of surgery are usually done in an outpatient setting and not in a hospital.
Phacoemulsification surgery is the most common type of cataract surgery. It is used more often than standard extracapsular surgery, even though they are similar procedures.
During phacoemulsification surgery
Two small incisions (one that is 1 mm and the other that is usually 3 mm) are made in the eye where the clear front covering (cornea) meets the white of the eye (sclera).
A circular opening is created on the lens surface (capsule).
A small surgical instrument (phaco probe) is inserted into the eye.
Sound waves (ultrasound) are used to break the cataract into small pieces. The cataract and lens pieces are removed from the eye using suction.
An intraocular lens implant (IOL) may then be placed inside the lens capsule.
Usually, the incisions seal themselves without stitches.
During extracapsular cataract extraction:
An 8 mm to 10 mm incision is made in the eye where the clear front covering of the eye (cornea) meets the white of the eye (sclera).
Another small incision is made into the front portion of the lens capsule, and the lens is removed, along with any remaining lens material.
An intraocular lens implant (IOL) may then be placed inside the lens capsule, and the incision is closed.
Anesthesia
Most cataract surgery is now done using a topical anesthetic (eyedrops) or a local anesthetic. Local anesthetic may involve a sedative for relaxation followed by an injection beside, under, or inside the eye to deaden nerves and prevent blinking or eye movement during surgery.
General anesthetic may be necessary for:
People with extreme anxiety that cannot be controlled with simple sedation or counseling.
People who are unable to follow instructions during surgery.
People who are allergic to certain local anesthetics.
People with other medical conditions that require the use of a general anesthetic.
Children.
What To Expect After Surgery
Before you leave the outpatient center, you will receive the immediate eye care that is needed after surgery. The surgeon reviews the symptoms of possible complications, eye protection, activities, medicines, required visits (see below), and what to do for emergency care if needed. Portions of the follow-up may be done by another health professional, such as an optometrist or community health nurse.
The eye that was operated on may be bandaged for one night after surgery. You will wear a protective shield over the eye at night for about a week. There is normally no significant pain after surgery.
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