Extracapsular Cataract Extraction (ECCE)

Extracapsular 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:

1. 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.

2. Capsulotomy:

   • An opening is created in the anterior lens capsule (usually a continuous curvilinear capsulorhexis or a can-opener technique).

3. 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.

4. Cortex Removal:

   • The remaining softer lens cortex is aspirated using irrigation and aspiration (I/A) instruments.

5. IOL Placement:

   • A posterior chamber intraocular lens (PCIOL) is implanted into the remaining capsular bag.

Advantages of ECCE:

• Suitable for dense cataracts that are difficult to emulsify with phaco.

• Lower cost (does not require expensive phacoemulsification machines).

• Useful in settings with limited resources or when phaco is unavailable.

Disadvantages of ECCE:

• Larger incision → higher risk of astigmatism and longer recovery.

• Requires sutures, which may induce suture-related complications (e.g., infection, irritation).

• Slower visual rehabilitation compared to phacoemulsification.

Indications for ECCE:

• Very hard or mature (hyper-mature) cataracts.

• Weak zonules or pseudoexfoliation syndrome (where phaco may be risky).

• In resource-limited settings where phaco machines are unavailable.

Comparison with Other Techniques:

Feature	ECCE	Phacoemulsification	ICCE
Incision Size	8–10 mm	2–3 mm	10–12 mm
Capsule	Posterior remains	Posterior remains	Entire lens removed
Nucleus Removal	Manual expression	Ultrasound breakup	Whole lens removed
IOL Placement	In the bag	In the bag/sulcus	Anterior chamber or sutured
Recovery	Slower	Faster	Slow, higher complications

Postoperative Care:

• Topical antibiotics and steroids to prevent infection/inflammation.

• Monitoring for complications like posterior capsule opacification (PCO), cystoid macular edema (CME), or retinal detachment.

Conclusion:

ECCE is a manual, large-incision cataract surgery that remains useful in certain cases, though phacoemulsification is the gold standard where available due to faster recovery and fewer complications.