- 17 Sep, 2024
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Extracapsular Cataract Extraction
Extracapsular Cataract Extraction
Extracapsular cataract extraction is one of the procedures you will use most commonly
when you start your cataract surgeries.
A cataract is the main cause of blindness in the world, affecting about 20 million people.
Yet cataracts are the most successfully treatable of all vision impairments.
There are different types of cataracts and different ways of treating them,
including the extracapsular cataract extraction
The term extracapsular means ‘outside the capsule’.
This refers to the thin membrane that surrounds the natural lens.
In an extracapsular cataract extraction, the lens is removed while this membrane,
or capsule, stays partially intact to support the artificial lens that will be inserted.
This differs from phacoemulsification, where the cataract is emulsified and ‘hoovered up’ by an ultrasonic probe.
Then a folded-up artificial lens is inserted through a tiny cut in the eye.
Another type, a small incision cataract surgery – manual or ‘SICS’, works more like an extracapsular
cataract extraction but uses a smaller incision.
The extracapsular cataract extractions training course is targeted towards individuals
in the medical field who are interested in expanding their knowledge and skills in this area.
The course objectives include understanding the anatomy of the eye, different types of cataracts,
indications for extracapsular cataract extraction, and preoperative evaluation.
The Extracapsular Cataract Extraction Training Course is also suitable for doctors
in the medical field such as ophthalmologists, optometrists, and physicians who hold an MD degree.
However, the educational background is the most important criterion for admission.
Ophthalmologists and optometrists must possess a degree in medicine,
while physicians should at least hold a medical degree before enrolling in the course.
Fundamentals of Extracapsular Cataract Extraction Training Course
Cataracts are white cloudy opacities visible through the natural pupil.
The most common type is an age-related cataract, which is associated with the aging process.
They are most likely to occur in those over the age of 60.
However, there are also traumatic cataracts resulting from injury to the eye and congenital
cataracts that can be inherited or occur in utero.
Symptoms of cataracts are progressive loss of vision, glare, changing glasses prescription, and monocular diplopia.
They are diagnosed through their appearance on slit-lamp biomicroscopy.
Generally, there is no age limit to having cataract surgery.
The decision is not based on whether to operate solely on the density of the cataract
but rather on the visual disability suffered by the patient and the impact
of the reduced vision on the patient’s quality of life.
Cataract surgery is successful in improving visual function in patients and there is sometimes
the temptation to operate on the good eye that the patient needs for their everyday activity
Preoperative Assessment
Through the Extracapsular Cataract Extraction Training Course the surgeon will train on Preoperative Assessment
The surgeon must check for any significant medical conditions that may affect the patient’s
ability to achieve the stated goals of cataract surgery.
Diabetes, lupus, rheumatoid arthritis, immunosuppression, and autoimmune disease,
for example, may affect postoperative wound healing.
A history of herpes, shingles, eczema of the eyelids, or dry eye would contraindicate
the use of a lid speculum to optimize exposure during routine cataract surgery.
Additionally, hypertension, anticoagulation, and the use of specific medications
may affect the choice of anesthesia and the risk of intraocular and orbital hemorrhage.
Surgical Planning
The Extracapsular Cataract Extraction Training Course included how to plan Surgical
Surgical planning begins. The type of intraocular lens to be used must be selected
and the keratometry values entered into the IOL Master,
a computer that helps to calculate the appropriate lens.
In addition to this, the patient’s eye must be measured using an A-scan ultrasound
to confirm the accuracy of the IOL Master and to determine the axial length of the eye,
The results of both the keratometry and the A-scan ultrasound, which are displayed as “IOL Summary Data”,
must be double-checked by the surgeon.
This data is then entered into the patient’s digital database, along with the type of lens to be used,
its power, and the selected surgical technique.
This documentation is important, as the patient’s details, the type of lens, and the chosen surgical
technique must be recorded on the Patient Booked Surgery form which is sent to administration
to ensure that the correct lens is ordered.
Surgical Techniques
Starting the Extracapsular Cataract Extraction surgical technique, the trainees are taught basic
safety tips such as foot positioning, how to hold a surgical instrument safely,
and how to avoid hitting the top of the wound with the phaco needle.
Then the instructors move on to the initial step, which is incision creation.
Incisions are usually made at the peripheral aspect of the cornea.
The main purpose is to create a self-sealing tunnel that maintains the intraocular pressure
within the eye during and after the surgical techniques.
Then the instructors will move on to teaching them about the next step, which is the capsulorhexis.
Capsulorhexis is the technique of making a circular opening to the anterior surface of the lens capsule.
It’s a very important step because if the circular tear can’t be completed,
the trainees will need to remove the torn sections from the eye first and then he or she needs
to use a vitreous cutter to cut the lens into pieces separately and remove them from the eye.
After the creation of the cystectomy opening, the instructors will teach the trainees how to perform
hydro dissection and then use the phaco handpiece.
The trainees are required to disassemble the handpiece correctly and then place the pieces
into a jar in preference of the cleaning nurse.
The trainees are also taught that caution and care should be used to avoid hitting
the posterior capsule and incurring a rupture with the phaco needle.
Extracapsular Cataract Extraction steps:
1- Incision and Capsulorhexis
During Extracapsular cataract extraction training, the trainees will learn
how to make an ideal incision and capsulorhexis.
They will first watch videos showing the proper way to make an incision.
These include the position of the incision, the type of knives used, and the direction and size of the incision.
The trainees will then practice making an incision on the model’s eyes.
A wet lab is where the trainees can practice different types of incisions a.
Observing the shape and features of the anterior capsule under the microscope,
the trainees will learn how to initiate the capsulorhexis with a cystectomy.
Continuous curvilinear capsulorhexis (CCC) is the preferred method.
The trainees will have the opportunity to practice capsulorhexis on the model eyes
while their performance is being monitored and guidance can be provided.
At the end of the capsulorhexis, the tips for a successful capsulorhexis will be explained
and demonstrated by the instructors on videos.
At the end of the section, the trainees are required to complete a multiple-choice examination
to test their understanding of the theory.
2- Nucleus Removal
The technique of phacoemulsification for removing a cataract has advanced tremendously
over the last few years. It involves the use of a high-speed ultrasound
system which has a needle about 2 mm or less in size at the end of a piece of equipment
that is inserted into the eye.
The system is used in the removal of the cataract by breaking it down
with the ultrasound and aspirating the pieces away.
Such advanced technology has allowed the development of the “no-stitch” cataract surgery,
often performed as day surgery under local anesthesia.
This involves the use of small incision phacoemulsification.
Hardenability: The term hard cataract is often used to describe an age-related cataract
with increased nuclear sclerosis, and it may feature in the cataract grading.
When a nucleus is removed conventionally, it is often sunk to the base of the eye denoting
the creation of the large posterior chamber space.
Instrumentation: A variety of instrumentation can be employed to achieve safe and efficient
removal of the cataractous nucleus.
It is crucial that the surgeon is familiar with the safe use of the various instruments and is competent in using them.
Each step of the surgical technique is taught with a practical demonstration.
3- Intraocular Lens Implantation
Following the removal of the cataract, an intraocular lens implant, or IOL, must be inserted.
The type of IOL used may vary, from a basic mono-focal lens to an advanced aspheric
mono-focal lens.
However, the aim of lens implantation surgery is always to ensure the greatest possible
improvement in the patient’s visual acuity.
The lens implantation therefore offers an opportunity to correct any pre-existing refractive
errors and reduce a patient’s reliance on visual aids
The main part of any IOL is the optic, which is a circular piece of plastic or silicone
that is designed to be placed in the lens capsule.
The optics on the market can vary in terms of material, although most modern IOLs have
ultraviolet filters and are made of a soft, foldable material, such as silicone.
By Extracapsular cataract extraction training on the most up-to-date and advanced methods for IOL insertion,
the quality of patient care can be constantly improved.
Extracapsular Cataract Extraction Training Course
In the MoAcademy training course, we will discuss and demonstrate the key stages in recent advances
in lens implantation, using up-to-date surgical video footage and talks from experts in the field of cataract surgery.
Clinicians who participate in the course will have the opportunity to study the various IOL options,
how to deal with complications, and also to improve their existing surgical methods.
By offering a comprehensive look into modern lens implantation,
the course aims to provide clinicians with the experience and understanding
needed to further improve patient care.
Crucially, the Extracapsular cataract extraction training will also teach participants
about the differences in surgical techniques necessary when using certain IOLs.
With toric, multifocal, and accommodating extended depth of focus IOLs all available,
there are numerous methods for correcting a patient’s vision during the lens implantation stage.
This presents a fantastic opportunity for surgeons to learn about the wide range of options
for patient-specific treatment when undertaking cataract surgeries.
By the end of the Extracapsular Cataract Extraction Training Course,
attendees will have a deep insight into IOL surgery and the required stages capable
of achieving success in such operations.
Such knowledge and skill are essential in pushing treatment options forward and ultimately
aiding in the global fight against vision impairment.