Intracapsular cataract extraction (ICCE) is a surgical procedure used to correct cataracts. The lens and the thin capsule surrounding the lens are removed. Before 1980, this procedure was popular but has since been overtaken by extracapsular cataract extraction which removes the lens but leaves the capsule intact. To remove the capsule, the surgeon has to make a large incision. Consequently, healing takes longer and the IOL is more difficult to implant. The patient also has to wear very thick glasses.
The lens is located behind the iris and focuses light on the retina. It is responsible for clear, sharp vision and has the ability to change shape, also known as accommodation. However, due to age, the lens hardens and loses its ability to accommodate. The dead cells that accumulate in the lens capsule cause the lens to cloud so that the clear, sharp vision is affected. Cataracts can be congenital. They can also form due to smoking, injury, exposure to toxins and diseases like diabetics.
The purpose of ICCE is to restore clear vision. Cloudy cataracts obscure vision so that performing normal daily activities may be a problem.
Preparation & expectation before Surgery
The surgery is usually an inpatient procedure though it can be an outpatient one depending on the needs of the patient. The following will help to prepare the patient for ICCE:
- An eye examination before the surgical procedure. The medical professional will conduct an ultrasound analysis to check that the retina is fine. The ultrasound measures the curvature of the eye too, to get an accurate prescription of the IOL. The doctor will check for infections such as blepharitis, conjunctivitis and nasolacrimal obstruction.
- It is essential that the patient undergoes a preoperative physical examination to rule out diseases that might complicate the ICCE procedure.
- The doctor will prescribe antibiotic eye drops or an ointment a day to the surgical procedure.
The following procedure is followed in an ICCE:
- The ophthalmic assistant gives the patient a mild sedative before the operation to help in relaxation. The assistant anesthetizes the area due for surgery using local or general anesthesia.
- The surgeon uses a speculum to keep the eyelid open to prevent from blinking.
- The surgeon applies pressure on the eyeball accompanied by a massage to reduce vitreous volume and prevent a vitreous bulge.
- The surgeon uses a topical anti-infection to prepare the skin in the operative area of the eye
- The surgeon makes an incision in the limbal area, the intersection of the sclera and the cornea. Medicine is inserted which allows the fibers that hold the lens in place to soften. The surgeon smears liquid nitrogen on the lens to freeze it by using a probe. Using the probe, he/she lifts the cornea and removes the lens capsule and the cataract. The entire natural lens and the capsule that hold it are removed.
- The surgeon then places an IOL in front of the iris and stitches the wound to keep the eye closed until it heals.
ICCE is more difficult in young patients due to the vitreous and the zonules being attached to the lens. The surgeon injects an enzyme into the lens zonules area to break up the attachments. This way, patients aged 30 to 60 can successfully have the procedure.
After care, recovery, results
Most patients will notice a significant improvement in vision. The patient experiences an improved perception of colors and can do activities such as reading, driving and needlework.
There are some things the patient should not do immediately after surgery like driving themselves home. Bending over or doing anything strenuous is not allowed for about two weeks. Rubbing the eye is forbidden.
The patient needs to wear glasses to protect the eye and a shield when sleeping to avoid bumping the eye.
The patient will continue to use antibiotics and take anti-inflammatory medication for two to three weeks.
Some may ultimately do away with eyeglasses or contact lenses.
Risks & complications
The following risks or complications may follow ICCE:
- Retinal detachment
- Hyphema (bleeding into the anterior chamber)
- Rapture of the capsule and loss of vitreous gel
- Central retinal inflammation or macular edema
- Choroidal hemorrhage (bleeding below the retina)
- Residue of small lens pieces in the back of the eye
- Intraocular infection, also known as endophthalmitis
- Corneal edema caused by a damaged corneal endothelium
- Posterior capsule opacity which is the clouding of the capsule
- IOLs can get dislocated or decentered requiring further surgery
- Postoperative glaucoma caused by increased intraocular pressure
- Corneal astigmatism can result if the edges of the wounds were not adequately sutured together
- Cystoid macular edema (when fluid leaks from the capillaries in the macula area). It is the most distressing complication since it can lead to decreased acuity