Module 5 – Surgical Technique & Placement

• Phacoemulsification & small-incision cataract surgery

• IOL insertion methods (foldable injector, rigid PMMA)

• Standard placement in the capsular bag

• Alternative placements (sulcus, anterior chamber, scleral fixation)

👁️ Major Surgical Techniques for Cataract Extraction

1. ECCE – Extracapsular Cataract Extraction

• Method: A large incision (10–12 mm) is made in the cornea or sclera. The cloudy lens nucleus is removed in one piece, while the posterior capsule is preserved for IOL placement.

• Use Case: Suitable for very dense or mature cataracts where phacoemulsification is not feasible.

• Recovery: Slower healing with sutures and higher risk of astigmatism.

• Visual Aid: Demonstrates manual technique challenges and step-by-step ECCE surgery.

2. Phaco – Phacoemulsification

• Method: A small incision (2–3 mm) is made, and an ultrasonic probe is used to emulsify the lens, which is then aspirated. A foldable IOL is inserted through the same incision.

• Use Case: Most commonly used worldwide, ideal for moderate cataracts.

• Recovery: Rapid recovery, often sutureless, with minimal trauma.

• Visual Aid: Clearly shows ultrasonic lens removal and IOL implantation.

3. Laser – Femtosecond Laser-Assisted Cataract Surgery (FLACS)

• Method: A femtosecond laser performs precise corneal incisions, capsulotomy, and lens fragmentation. Ultrasound may still be needed for residual lens removal.

• Use Case: Preferred for premium IOLs, astigmatism correction, or patients needing high precision.

• Recovery: Potentially faster, gentler, and with fewer complications in select patients.

• Visual Aids Include:

  • Standard vs. Laser Cataract Surgery – Duke Health

  • Cataract Surgery with Laser Lensx™ – Real-time surgical guide

  • Femtosecond Laser-Assisted Cataract Surgery – 3D animations and expert commentary

  • YouTube Short: “How Does Laser Cataract Surgery Work?”

🧪 Step-by-Step Surgical Technique

A. Phacoemulsification Procedure

• Lens Emulsification: Cataractous lens is fragmented using ultrasound.

• Aspiration: Fragments are removed via micro-incision (~2–3 mm).

• Capsulorhexis: A round opening is created in the anterior capsule.

• IOL Insertion: A foldable acrylic IOL is injected into the capsular bag, where it unfolds securely.

🔍 Placement of IOLs

1. Capsular Bag (Preferred Standard)

• Offers maximum stability.

• Reduces risk of decentration or tilt.

2. Ciliary Sulcus Placement

• Used when the posterior capsule is damaged.

• Requires precise sizing and fixation.

3. Anterior Chamber IOL (ACIOL)

• Placed in front of the iris.

• Used only when both capsular bag and sulcus are unsuitable.

• Less common due to higher complication risks.

4. Scleral-Fixated or Iris-Claw IOL

• For eyes without any capsular support.

• IOL is sutured to sclera or clipped to iris.

⚠️ Surgical Considerations

• Ensure secure wound sealing to prevent leakage.

• Maintain precise centration of IOL for optimal vision.

• Avoid complications such as:

  • Posterior capsule rupture

  • Vitreous loss

  • IOL tilt or decentration

⭐ Key Takeaway

The gold standard today is phacoemulsification with a foldable acrylic IOL placed in the capsular bag.

Alternative placements are reserved for complex or compromised cases where standard placement isn’t feasible.

🏥 ECCE vs. Phacoemulsification: Cataract Surgery Techniques

🧪 Practical Implications for Concordia Staff Training

• ECCE may still be relevant in rural outreach or low-resource settings. It’s also useful when phaco machines are unavailable or the cataract is too hard for safe emulsification.

• Phaco is the gold standard in urban and private settings due to its precision and faster healing.

2. YouTube Learning References (2 for Module 5)

1. Phacoemulsification Cataract Surgery with IOL Implantation

2. IOL Placement Techniques – Bag, Sulcus, Scleral Fixated

3. FAQs (5) – Dual Language

Q1 : What is the gold standard technique for IOL implantation?  IOL Implantation အတွက် အထူးအဆင့်မြင့်နည်းလမ်းက ဘာလဲ?

Phacoemulsification with foldable IOL in the capsular bag.  Phacoemulsification ပြုလုပ်ပြီး Foldable IOL ကို Capsular Bag ထဲ ထည့်သွင်းခြင်း။

Q2 : Where is the preferred site for IOL placement?  IOL ထည့်သွင်းရန် အကောင်းဆုံး နေရာက ဘယ်လဲ?

Inside the capsular bag. Capsular Bag အတွင်း ဖြစ်သည်။

Q3 : When is sulcus placement considered?   Sulcus Placement ကို ဘယ်အချိန် သုံးသလဲ?

When the posterior capsule is damaged or missing.  Posterior Capsule ထိခိုက်သည့်အချိန် သုံးသည်။

Q4 : What is an anterior chamber IOL (ACIOL)?  Anterior Chamber IOL ဆိုတာ ဘာလဲ?

An IOL placed in front of the iris when capsular support is absent.  Capsular Support မရှိသည့်အချိန်တွင် Iris ရှေ့တွင် ထည့်သွင်းသည့် IOL ဖြစ်သည်။

Q5 : What ensures stability and good vision after IOL surgery?  IOL Surgery ပြီးနောက် တည်ငြိမ်ပြီး မြင်ကွင်းကောင်းစေရန် အဓိက အချက်က ဘာလဲ?

Proper centration and fixation of the IOL.  IOL ကို မှန်ကန်စွာ အလယ်တည်နေရာတင်ခြင်းနှင့် တည်ငြိမ်စွာ ထိန်းသိမ်းခြင်း ဖြစ်သည်။

✅ This completes Module 5: Surgical Technique & Placement of IOLs with:

• A4 reading handout

• 2 YouTube references

• 5 FAQs (EN + MM)

• 10 MCQs (EN + MM)