Simultaneous Bilateral Cataract Extraction: ECCE versus ICCE

Abstract

OBJECTIVE: To evaluate the differences in visual rehabilitation between intracapsular (ICCE) and extracapsular (ECCE) cataract surgery as well as the significance for visual performance of the position of an intraocular lens in the eye. STUDY DESIGN: Prospective study of simultaneously performed cataract extraction in both eyes, with evaluation at 3 days, 6 weeks, 3 and 6 months after surgery. PATIENTS: Ten adult patients severely visually handicapped from equally advanced cataract in both eyes had simultaneous cataract surgery performed under general anaesthesia with an ECCE with a posterior chamber lens (PCL) in one eye and an ICCE with an anterior chamber lens (ACL) in the other eye. MAIN OUTCOME MEASURES: Refraction and visual acuity (VA) were obtained unbiased by a trained nurse with an autorefractor and with the same instrument a value for contrast (CS) and glare (GS) sensitivity were obtained, expressed as the numerical drop in Snellen lines from the best visual acuity obtained at the same time. RESULTS: After 6 months all patients seemed to have benefited almost equally in both eyes (mean VA/ECCE 0.72 ± 0.15); and mean VA (ICCE 0.80 ± 0.16). No subjective differences in visual performance was noticed between the eyes except in one of the ECCE patients, who experienced the beginnings of opacification in the posterior capsule. There were no significant differences in either CS (ECCE: 2.7 ± 1.8 and ICCE: 3.4 ± 1.3; P = 0.37) or GS (ECCE): 4.4 ± 1.6 and ICCE: 5.2 ± 1.9; P = 0.21) after 6 months. There was no significant difference in intraocular pressure, and no corneal or retinal complication occurred in either group. CONCLUSION: When ICCE and ECCE have been compared, it has always been by retrospective study of different patients operated on by different surgeons, using different microsurgical techniques and with different observation periods. This study is a unique attempt to evaluate the two surgical techniques in a prospective manner. During an observation period of 6 months no differences occurred in visual rehabilitation between ECCE/PCL and ICCE/ACL, when these procedures were performed at the same time in a small number of patients having simultaneous bilateral cataract surgery.