Intracapsular Cataract Extraction (ICCE): Procedure & History

Intracapsular cataract extraction (ICCE) removes the entire lens within its capsule. It was standard until the 1980s but is now rarely performed, replaced by extracapsular (ECCE) and phacoemulsification.

ICCE Steps

1. Corneal/scleral incision (large, ~10–12 mm).
2. Anterior chamber entry.
3. Capsulotomy (can-opener or forceps).
4. Hydroexpression/forceps removal of intact lens-capsule complex.
5. Irrigation/aspiration of residual cortex.
6. Sutured wound closure (multiple sutures).
7. Aphakic correction: thick glasses, contact lens, or secondary IOL (scleral-fixated, anterior chamber).

Complications (Higher vs. Modern Techniques)

• Vitreous loss (no posterior capsule barrier) → retinal detachment risk.
• Cystoid macular edema (inflammatory).
• Endophthalmitis.
• Glaucoma (pupillary block, angle closure).
• Large incision → astigmatism, wound dehiscence.

Current Indications (Rare)

• Subluxated/dislocated lens (trauma, Marfan, homocystinuria).
• Pediatric cataracts with capsular instability.
• White/intumescent cataracts where capsulorrhexis impossible.

Phacoemulsification (2.2–2.8 mm incision, foldable IOL) offers faster recovery, less astigmatism, lower complication rates.