Wydanie 3/2004

Minimizing the incision in cataract surgery - a continuous challenge

Wojciech Omulecki, Michał Wilczyński

Department of Ophthalmology Medical University of Łódź Head: Wojciech Omulecki, MD, PhD

Summary: The aim of this paper was to present the history of cataract surgery with a special regard to the size of incision. This history dates back to the 8th century B. C, but in 18th century, since Daviel's times, the history of modern cataract surgery begins. Daviel's surgery was an extracapsular cataract extraction (ECCE). In the later period, lasting from the 18th century until the mid-seventies of the 20th century the technique of intracapsular cataract extraction (ICCE) dominated. The return to extracapsular technique (ECCE) was related to the introduction of intraocular lenses by Harold Ridley in 1949. By introducing phacoemulsification Charles Kelman changed the route of development of techniques of ECCE toward minimizing the incision. The incision in ICCE technique is usually 14 ? 16 mm. The incision in ECCE, depending on the size and the degree of nuclear sclerosis, is approximately 10 ? 12 mm long. Unlike the planned ECCE, phacoemulsification is a procedure, in which the nucleus is ultrasonically fragmented and aspirated by a small incision (about 3 mm). ?Small incisions? used the most frequently by now are: scleral tunnel ranging from 3 to 7 mm and clear corneal incisions ranging from 2.8 to 4.0 mm. The further fast development of surgical techniques enabled the possibility of replacement of ?small incisions? by a micro incision ? MICS (micro incision cataract surgery). The latest phacoemulsification devices equipped with functions, like: low-frequency oscillatory movements, phaco burst, phaco pulse or sonic phacoemulsification allow to minimize the unfavourable heating of the sleeveless tip ('cold phaco'). There are few different intraocular lenses present on the market, designed for implantation through a micro incision. High stability of the incision, quick wound healing, fast patient rehabilitation and minimal induced astigmatism are the advantages of this method. This process still lasts and its further steps may be: further development and application of laser techniques, improvement of phacoemulsification devices and introduction of liquid, injectable intraocular lenses.

Keywords: cataract surgery, techniques, incisions