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c. Phacoemulsification.

Visual results can be improved in all these types of surgeries by adhering to these common
guidelines.
 A well planned incision that minimizes surgically-induced astigmatism.
 Safe and secure incision.
 Ensuring minimal loss of the corneal endothelial cells
 An appropriate posterior chamber IOL placed in the capsular bag.
 Avoiding trauma to iris, and other ocular tissues.

Incision location, size, and design may depend on several factors, including the patient's

orbital anatomy, the type of IOL to be implanted, the role of the incision in astigmatism
management, and surgeon preference and experience.
Manual small incision cataract surgery: This surgery is known to be extremely cost

effective and visual improvements are comparable to other technique like
phacoemulsification. This can be performed through superior incisions or temporal
incisions. While superior incisions would be relatively safer with regard to the occurrence
of endophthalmitis (since the incision is protected by the lids), it causes a higher
astimagtism than the temporal incision. If temporal incisions have to be performed
because of excessive preoperative astigmatism, care should be taken to fashion a longer
internal corneal valve and the tunnel may be secured with a couple of nylon sutures. While
any type of anterior capsular opening techniques can be used alongside this procedure,
capsulorrhexis is preferred for better centration of the intraocular lenses and reduced

inflammation. The cataractous lens can be taken out by irrigating vectis or by
viscoexpression. Rigid or foldable lenses can be used as per the needs of the individual
patient.

Extra capsular cataract surgery:

This surgery can be performed on hard cataracts, shallow anterior chambers or a bulky
nucleus which may be difficult to express through a smaller incision. The decision to
perform this surgery has to be decided upon by the needs of the patients along with the
comfort level of the surgeon. The main drawback of this surgery is the increased need for
postoperative follow ups which may be necessitated due to problems associated with
sutures. Astigmatism can also be a significant issue which may warrant a suture removal, in
order to optimize good uncorrected visual acuity.

Phacoemulsification: This surgery can be performed on early to intermediate level of
hardness of cataract and produces rapid visual recovery. It also eliminates the risk of
regional anasthesia since it may be performed topically. There is a learning curve for
surgeons and once it is mastered, it can be employed in a significant number of cases.
Harder cataracts may require an experienced surgeon and a machine with good fluidics.

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