Advanced Suture less Cataract Surgery

Cataract surgical techniques have changed enormously in the last ten years, both in the developed world and the developing world, and will undoubtedly continue to change at an ever-increasing rate. Phacoemulsification is now the standard, and almost the only procedure in the developed world. For various reasons, most experts in the developing world do not see phacoemulsification as the answer to world cataract blindness, although there are a few ‘phaco enthusiasts’ who do.

An effective cataract surgeon in the developing world is one who is doing high volume, low cost and low complication surgery. For many of these effective cataract surgeons, the operation of choice is now sutureless non-phaco cataract extraction, and others are changing to this technique. The purpose of this article is to try to describe the principles of this technique (there are several different ways of doing it) , its advantages and disadvantages and how to avoid mistakes and complications.

Sutureless non-phaco cataract surgery requires three separate and different steps:

• The incision is made so as to be self-sealing and as free from resulting astigmatism as possible. At the same time, it needs to be large enough to allow the entire lens nucleus to be removed in one piece.
• The nucleus is then mobilised inside the eye, and inside the lens, to enable it to be removed.
• The nucleus is then removed without damaging either the cornea or the posterior lens capsule.