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NR. 3(I)/2004
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Minimizing the
incision in cataract surgery – a continuous challenge
Wojciech Omulecki, Micha³
Wilczyński
Department of Ophthalmology Medical University of £ód¼
Head: Wojciech Omulecki, MD, PhD |
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| 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. |
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| Key words: |
cataract surgery,
techniques, incisions. |
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