Phacoemulsification   (or "phaco") is the   gold standard   for cataract surgery, using   ultrasonic energy   to break up and remove the cloudy lens through a   tiny incision (2–3 mm) . It allows for rapid recovery, minimal induced astigmatism, and excellent visual outcomes. Key Steps in Phacoemulsification 1. Incision Main corneal incision  (2.2–2.8 mm, self-sealing). Side-port incision  (1 mm, for second instrument). 2. Capsulorhexis Continuous curvilinear capsulorhexis (CCC)  (~5–6 mm diameter) to access the lens. 3. Hydrodissection & Hydrodelineation Fluid injection  to separate the nucleus from the cortex and capsule. 4. Nucleus Emulsification Phaco probe  uses  ultrasonic vibrations  to break up the nucleus. Common  phaco techniques : Divide & Conquer  (groove and split nucleus into quadrants). Stop & Chop  (central groove + chopping). Prechop  (manual segmentation before phaco). 5. Co...

Small Incision Cataract Surgery (SICS)   is a refined, manual extracapsular cataract extraction (ECCE) technique that uses a   self-sealing sclerocorneal tunnel incision   (typically 5–7 mm) to remove the cataract and implant an intraocular lens (IOL). It is a cost-effective alternative to   phacoemulsification , especially in resource-limited settings where advanced equipment is unavailable. Key Features of SICS Incision: Location:  Sclera or limbus (unlike ECCE’s larger corneal incision). Size:  5–7 mm (smaller than ECCE’s 8–10 mm, but larger than phaco’s 2–3 mm). Design: Triplanar self-sealing tunnel  (prevents leakage without sutures). Blunt dissection  into the anterior chamber. Anterior Capsulotomy: Continuous curvilinear capsulorhexis (CCC)  (preferred) or  can-opener technique . Nucleus Delivery: Hydrodissection  to free the nucleus. Manual expression  using a  wire vectis  or  fishhook technique  (n...

Ex tracapsular Cataract Extraction (ECCE)   is a surgical technique used to remove a cataract while leaving the posterior capsule of the lens intact, allowing for the implantation of an intraocular lens (IOL). It is an alternative to   phacoemulsification   (modern small-incision cataract surgery) and   intracapsular cataract extraction   (ICCE, which removes the entire lens and capsule). Key Features of ECCE: Incision: A larger incision (typically 8–10 mm) is made in the cornea or sclera compared to phacoemulsification (2–3 mm). May require sutures for closure. Capsulotomy: An opening is created in the  anterior lens capsule  (usually a continuous curvilinear capsulorhexis or a can-opener technique). Nucleus Removal: The hard central nucleus of the cataract is manually expressed or prolapsed out of the eye. Unlike phacoemulsification, ultrasound energy is  not  used to break up the nucleus. Cortex Removal: The remaining softer lens cortex is...

Ocular anesthesia ensures   pain-free surgery , while   akinesia   (absence of movement) prevents complications from involuntary eye movements. The choice depends on the procedure (e.g.,   cataract surgery, glaucoma surgery, retinal surgery ) and patient factors. 1. Types of Ocular Anesthesia A. Topical Anesthesia Used for : Phacoemulsification, clear corneal incisions (minimally invasive procedures). Agents : Proparacaine 0.5%  (rapid onset, short duration). Lidocaine 2% gel  (longer-lasting, better comfort). Advantages : No needle, quick recovery. Patient can cooperate (e.g., fixate on microscope light). Disadvantages : No akinesia (eye can still move). Risk of pain if surgery becomes complicated. B. Sub-Tenon’s Anesthesia Technique : Blunt cannula delivers anesthetic beneath Tenon’s capsule. Agents :  Lidocaine 2% + Bupivacaine 0.5%  (with or without Hyaluronidase). Advantages : Good anesthesia & mild akinesia. Lower risk of globe perforati...