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Extracapsular cataract extraction (ECCE) is a traditional type of cataract surgery. An incision is made in the cornea in order to remove the cloudy lens and replace it with a clear artificial one.
ECCE is one of a few types of cataract surgeries. Phacoemulsification and laser-assisted cataract surgery are also available.
Extracapsular cataract extraction is safe, effective, and an affordable cataract surgery option. Downsides to the procedure include a larger incision in the cornea and a slightly longer recovery time than with other types of cataract surgery.
If you have been diagnosed with cataracts, there are some home treatment options that can help you manage your cataract symptoms before you need surgery. Once your cataracts interfere with your ability to do activities you enjoy, it may be time to consider surgery.
Recovery from cataract surgery is relatively quick. You can expect to experience some mild symptoms after surgery, but most people make a full recovery within a few days to weeks.
Extracapsular cataract extraction is a well-developed surgery. Approximately 90 to 95 percent of patients report satisfactory results after receiving ECCE.
What Is Extracapsular Cataract Extraction?
Extracapsular cataract extraction (ECCE) is a type of cataract surgery that removes cloudy cataracts from the eye.
It has been performed for hundreds of years around the world, and modernization of the technique has made it a highly effective and safe procedure. With ECCE, an incision is made into the eye so that the cloudy lens can be removed in one piece.
ECCE is unique in that the elastic capsule that covers the lens is left in place. A relatively large incision is made into the cornea or sclera of the eye so the natural lens can be removed and then replaced by a new artificial intraocular lens (IOL).
ECCE can be performed via manual expression, where an eye surgeon performs the procedure and removes the lens, or phacoemulsification.
How It Compares to Other Types of Cataract Surgery
In traditional ECCE, a large incision is manually made into the patient’s cornea to allow for removal of the cloudy lens.
Surgeons may elect for this type of surgery when phacoemulsification cannot effectively break up cataracts on the patient’s lens. However, other types of cataract surgeries are also available that may meet patient needs better than ECCE can.
Types of cataract surgery include:
- Small incision cataract surgery (SICS) or phacoemulsification. A small incision is made into the side of the cornea with SICS. A small probe is then inserted into the eye that emits ultrasound waves to break up the cloudy lens before being suctioned out. An IOL is then inserted into the eye.
- Laser-assisted cataract surgery. Via laser-assisted surgery, an ultrasound device is first placed over your eye to map its surface and gather data about your lens. The information is sent to a laser that an eye surgeon uses to make an incision into the cornea and open the lens capsule. Ultrasound waves are then used to break the lens into pieces before being suctioned out. Once the old lens is removed, the surgeon inserts an IOL.
With the above cataract surgeries, stitches are usually not needed. Eye surgeons seal the incision with a special liquid that allows the eye to heal on its own.
The recovery time for traditional and laser-assisted cataract surgery is the same. Most people experience better vision almost immediately, explains the American Academy of Ophthalmology.
Laser-assisted surgery is typically more expensive and not always covered by insurance. Additionally, it can only be offered to patients who have selected a premium IOL or who have astigmatism that they want corrected during surgery.
Laser-assisted surgery offers a more precise procedure that can be done in less time. It can increase accuracy and consistency, and provide better vision correction than traditional surgery can.
Pros & Cons of Extracapsular Cataract Extraction
ECCE provides a safe and effective way to remove cataracts from the eye. The surgery has been developed over many years, but as with any surgery, there are risks and benefits associated with the procedure.
- It is a treatment option for advanced cataracts that cannot be dissolved via phacoemulsification.
- An artificial lens of your choice can be implanted.
- Recovery is relatively quick, and the procedure is successful for most people.
- It is typically covered by insurance, making it an affordable cataract treatment option.
- A larger incision must be made in the cornea than with other types of cataract surgery.
- The incision requires stitches to close the larger cut, whereas other types of cataract surgery do not require stitches.
- Although recovery is relatively fast, it may take longer to recover from ECCE than other cataract surgeries.
The type of cataracts you have and how advanced they are can indicate if ECCE will be the best treatment approach.
While other surgery options exist that do not require stitches or such a large incision, extracapsular cataract extraction may still be the best surgery option due to pre-existing eye issues or other health conditions. Discuss the pros and cons of ECCE with your eye doctor to determine if it is the right type of cataract surgery for you.
Who Should & Shouldn’t Consider ECCE
Anyone should consider cataract surgery if they have cataracts that are impacting their vision to the point where they can no longer do activities they want. If you are still able to perform your regular activities without major obstruction and with the help of minor interventions, it may not be time for surgery.
If your cataracts are not too bothersome, consider trying the following prior to surgery:
- Update your eyeglass or contact lens prescription.
- Wear sunglasses and a hat when out in the sun.
- Use bright lights for reading and other near vision activities.
- Stay on top of health conditions, such a diabetes, and do not smoke.
- If night vision, glare, or halos are problems for you, avoid driving at night.
If it is still difficult to complete activities of daily living after trying the above accommodations, it may be time to consider cataract surgery.
Cataract surgery is the only way to remove cataracts, so speak with your ophthalmologist about your surgery options. ECCE may be the right treatment approach if your cataracts cannot be removed via phacoemulsification because they are too large or because of additional eye conditions.
What Recovery Looks Like
Recovery from cataract surgery, including extracapsular cataract extraction, is relatively rapid. Many people start to feel better after a few days, while others take four to six weeks to make a full recovery. Whether you choose traditional or laser-assisted cataract surgery, you should be able to go home within an hour or so of your surgery.
After cataract surgery you can expect:
- Mild symptoms, such as grittiness, watery eyes, blurred or double vision, and red or bloodshot eyes.
- Feeling to return to your eye within a few hours.
- Vision to return within a few days, though it may not be perfectly clear.
- Your doctor to prescribe eye drops.
- Instruction to rest for a couple of days and avoid strenuous exercise and sports.
- To use an eye shield while sleeping.
- To use an eye shield, glasses, or sunglasses when outside.
- To have the ability to read, watch television, and use a computer right away.
Your ability to return to certain activities, such as driving, flying, swimming, and exercising, will depend on your response to the surgery. Some people are able to drive the day after surgery, while it takes a few weeks for other people to feel up to this.
Activities where contaminated water could get in your eye, such as swimming, are best avoided for four to six weeks after surgery.
Success Rates of Extracapsular Cataract Extraction
ECCE techniques have greatly improved since they were first introduced to the world in the mid-1700s, leading to high success rates. The overall success rates of the procedure are now around 90 to 95 percent. The procedure is safely performed around the world, including in the United States.
Extracapsular cataract extraction is an extremely effective procedure that produces positive visual outcomes due to the use of the intraocular lens and refinement of the procedure. Talk to your eye doctor about whether it is right for you.
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Extracapsular Cataract Extraction. Encyclopedia of Surgery.
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The Evolution of Cataract Surgery. (January 2016). U.S. National Library of Medicine.
Traditional Cataract Surgery vs. Laser-Assisted Cataract Surgery. (August 2019). American Academy of Ophthalmology.