Phacoemulsification with Intraocular Lens Implantation
The recommended procedure for cataract surgery is small-incision phacoemulsification with foldable intraocular lens (IOL) implantation, performed on an outpatient basis. 1
Standard Surgical Technique
Phacoemulsification is the predominant method of cataract surgery in the United States and much of the developed world, utilizing sutureless small incisions with foldable IOL implantation. 1
The procedure is typically performed without sutures, though sutures or sealants may be used for incision closure if needed. 1
This technique produces superior uncorrected distance visual acuity (UDVA) and lower rates of surgical complications compared to manual extracapsular cataract extraction (ECCE), including reduced rates of iris prolapse and posterior capsule rupture. 1
Key Advantages of Phacoemulsification
Phacoemulsification limits astigmatic changes that occur with larger incisions, enabling both astigmatism management and implantation of specialty IOLs. 1
The small-incision approach allows for faster visual recovery and earlier stabilization of refractive outcomes compared to traditional large-incision techniques. 1
Alternative Techniques (Context-Dependent)
Manual small-incision cataract surgery (MSICS) remains popular in economically disadvantaged countries due to cost-effectiveness, though it is not the standard in Western practice. 1
Femtosecond laser-assisted cataract surgery (FLACS) increases capsulorrhexis circularity and centration and may reduce ultrasonic energy requirements, but is not yet cost-effective and has not demonstrated superior overall risk profiles or refractive outcomes compared to standard phacoemulsification. 1
Common Pitfalls
Manual extracapsular cataract extraction should be part of a surgeon's skill set but is not a replacement for phacoemulsification in Western countries. 2
Anterior capsule tears during phacoemulsification can lead to additional complications, with 24% concurrent posterior capsule rupture rates and worse refractive outcomes, particularly if the IOL is implanted out of the bag. 3