Extracapsular Cataract Extraction (ECCE)

Extracapsular cataract extraction is a method of a cataract surgery that involves removing the eye's natural lens while leaving in place the back of the capsule that holds the lens in place. The procedure requires a much smaller incision than the older procedure called intracapsular cataract extraction in which the lens and the entire capsule were removed. A modified form of extracapsular cataract extraction is called phacoemulsification and uses an even smaller incision, requiring no sutures at all.

To understand the significance of ECCE, it is important to understand what a cataract is and how it interferes with vision. The eye works like a camera with two lenses. The first lens is the cornea, a clear membrane that covers the front of the eye. The second lens is the eye's natural crystalline lens, which is held in place by a capsule located behind the pupil (See Anatomy of the Eye). The cornea is responsible for about 70 percent of the eye's focusing power, while the natural lens fine-tunes the image.

When the natural lens becomes cloudy, usually because of the aging process, it keeps light rays from passing through or diffuses the light in such a way that vision becomes fuzzy or hazy. This cloudy lens is called a cataract. The object of modern cataract surgery is to remove this hazy lens and to replace it with a tiny plastic prescription lens that is permanently implanted in the eye.

In extracapsular cataract extraction, the surgeon makes a tiny incision in the white of the eye near the outer edge of the cornea. The size of this opening depends on whether the nucleus of the lens is to be removed all in once piece or whether it will be dissolved into tiny pieces and then vacuumed out (phacoemulsification). The surgeon then enters the eye through this incision and carefully opens the front of the capsule that holds the lens in place. After the nucleus or hard center of the lens is removed, the soft lens cortex is suctioned out, leaving the back of the capsule in place in order to strengthen and support placement of the intraocular lens.

After the natural lens is removed, a prescription intraocular lens implant is placed behind the iris, where the eye's natural lens used to be. The incision through which the lens was removed requires sutures if the lens was removed in one piece. If the phacoemulsification technique is employed, sutures are usually not required to close the incision.

Although glasses may still be necessary for some tasks after cataract surgery, most patients are happy with the results.