oECCE with posterior chamber intraocula lens implantation achieves results equal to phacemulsification in expert hands and has been an accepted method of cataract surgery.

1. ECCEPearls Cataract 39th Annual All Gujarat Ophthalmology conf Hall A 25th SEP 2011 10.30 to 11.15amGandhinagar. Dr. Anand Sudhalkar Baroda

2. Cataract: ? Vision loss Potentially a seeing eye AIM: Restore vision to its original level Avoid Iatrogenic causes of vision losses.

3. The Quest to Perfection Couching (Shushruta B. C.) Old ECCE Upto 1940 ICCE (1940-1982), 8/0 silk suturing cryo, Aphakic glasses Instant gain, permanent loss Infection, Poor healing Wide acceptance,

4. 1982-1984 AC IOL????

5. Era of Modern ECCE 1984-1992 Microscope 10/0 Sutures I/A concept Deep chamber concept Barrier concept Vitreous protection Posterior chamber IOL Phaco (1992)

6. Why ECCE today ? Rock Hard Cataract Lack or Insufficient Phaco experience Improper equipments No OVD Machine failures

7. Safety-of ECCE Concerns Large wound, risk of expulsive Infection Astigmatism Solutions Akinesia Anesthesia Good suturing, post op care Selective suture removal

8. The Incision Fornix based conj flap Bipolar cautry 9mm Limbalpartial thickness incision

9. Preplaced Sutures Assured wound alignment Stay Knot Safety in emergency

10. Large capsulotomyRhexis

11. Large CapsulotomyCan opener

12. Nucleus Delivery Easy Nucleus prolapse through open wound No complicated intraocular manipulations Can tackle rock hard cataracts.

13. Prompt Wound Closure Pull preplaced 8/0 sutures Knot lateral sutures Central suture pulled with slip Knot

14. Open wound I/A

15. Closed Chamber I & A Keep AC formed Bimanual approach for sub incisional cortex. Low bottle height

16. Simcoe cannula 30cc BSS !!!! Flat shaft – minimum chamber loss Manually controlled aspiration with syringe Easy reflux if capsule sucked.

17. IOL insertion Fill Visco in AC Single/three piece rigid IOL placement Trailing haptic inserted after tying central suture.

18. IOL Dialling

19. Replace 8/0 with 10/0

20. Summary Safe technique, Easy to teach Minimum equipments, Minimum disposables (economical) Reproducible Stood test of time, patient satisfaction, Life-Eye saving in awkward situations

21. Thank You

24. Sushruta times: COUCHING Since 2000 bc Fastest Instant vision High rate of complications Last case detected 1989

25. ECCE + PC IOL 1984 onwards Mastering art of suturing corneo-scleral wound, reducing astigmatism Attaining highest degree of Surgical perfection. We reached the peak of success in ECCE with PC IOL and patient satisfaction PHACO (1992)

26. Sutureless ECCE(Early 19th century) Van grafe knife section Passing through iris, lens capsule Couching out nucleus Open wound Full of complications

27. Era of ICCE ( 1950 to 1982) Most widely practiced Discussed in conferences Cryo extraction High visual gain Aphakia

29. ICCE + AC IOL (1982-1984) Success of good ICCE Angle and iris supported IOL UGH syndrome Pseudophakic Bullous Keratopathy

30. Era of ECCE (1984) First Microsurgical introduction to ophthalmology Importance of “Barrier” effect Irrigation-Aspiration concept Corneal protection concept Concern for Astimatism