Extracapsular extraction techniques still vital for cataract surgeons
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WAILEA, Hawaii — Cataract surgeons should remain familiar with extracapsular cataract extraction techniques, according to a speaker at Hawaiian Eye 2024.
Sumitra Khandelwal, MD, said extracapsular cataract extraction (ECCE) techniques are becoming less common, but they still have a vital role in extracting dense lenses.
“We’re lucky with the phaco techniques and phaco platforms we have that it’s not that common,” she said. “It’s important to know some of these little tricks because as we do less, or really no, extracaps over the last decade, there are little keys and tips that end up getting lost.”
The first step in converting to ECCE is to alert the surgical team and ensure the appropriate anesthesia is on hand. Khandelwal said it might be appropriate to create a sub-Tenon’s block.
It is important to know how to create a scleral tunnel for ECCE. She said that using a scleral tunnel rather than enlarging the corneal wound, which can create astigmatism and flattening that is difficult to correct, can be a good option for these cases.
She uses a can opener rhexis on lenses that might be particularly large and might cause tension on a smaller capsulorrhexis. It can also be a good way to connect the rhexis if it becomes disjointed.
Finally, Khandelwal said she uses hydrodissection in some of these cases. One technique is to prolapse the lens up and then place an irrigating lens loop.
“It’s not the mechanical movement of the irrigating lens loop — it’s the irrigation that really rocks that lens out of its position,” she said.
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Khandelwal S. Conversion to ECCE. Presented at: Hawaiian Eye 2024; Jan. 13-19, 2024; Wailea, Hawaii.
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