What is Cataract Surgery? A Comprehensive Guide from an Expert's Perspective

As an expert in the field of ophthalmology, I'm often asked about cataract surgery. This procedure involves replacing the natural lens of the eye with an intraocular lens, and it's a common treatment for age-related cataracts. In this article, I'll explain the two main types of cataract surgery - extracapsular and phacoemulsification - and discuss the risks and benefits associated with each.

Extracapsular

Extracapsular cataract surgery involves removing the lens that has become opacified and replacing it with a prosthetic lens. The human lens is 9 mm long and 4 mm wide and is composed of protein fibers that are arranged in a pattern that allows light to pass through. The best cataract surgical techniques remove the nucleus of the lens with minimal stress, using a large, unperforated plastic drape and a watertight incision. These techniques apply to all types of cases and give reproducible results. The best cataract surgical techniques also minimize astigmatism. During the procedure, the patient receives anesthesia, and sterile drapes cover most of the face. The area around the eye is cleaned with an antiseptic, and then the prosthetic lens is inserted and closed with saline. Compared to extracapsular cataract extraction (ECCE), phacoemulsification (PE) surgery is less prone to endothelial cell loss, peripheral cystoid macular edema, and capsule opacification. The World Health Organization estimated in 1997 that cataracts are responsible for 50% of blindness worldwide. As a result, extracapsular surgery has been used in many developing nations. However, it is rarely performed in North America and Europe due to its higher rate of posterior capsular opacification and early postoperative inflammation.

Phacoemulsification

Phacoemulsification has become the preferred method of extracapsular cataract surgery in the United States. It is also used as a treatment for trauma cataracts. This procedure is relatively quick, requires less than an hour, and is more cost-effective than conventional cataract surgery. The procedure involves removing the cloudy natural lens and introducing an intraocular lens (IOL) into the eye. The IOL is typically a PMMA lens that is inserted through a two-millimeter incision. It is believed that this method reduces the risk of complications and provides an ideal postoperative visual outcome. It also reduces the risk of astigmatism and is less painful than conventional cataract surgery. Phacoemulsification has evolved from a posterior chamber phaco to an anterior segment phaco, also known as micro-phakonit or micro-incisional cataract surgery. The procedure has been developed to minimize complications and enhance visual outcomes, but it also has a learning curve for newer cataract surgeons. Therefore, it's best to perform cataract surgery with an experienced surgeon.