Cataracts and Cataract Operations (Second of Two Parts)* THOMAS J. LIESEGANG, M.D.  Mayo Clinic Proceedings  Volume 59, Issue 9, Pages 622-632 (September 1984) DOI: 10.1016/S0025-6196(12)62415-X Copyright © 1984 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 5 Steps in intracapsular cataract operation. A, Cryoprobe is activated by N2 or CO2 source. B, Conjunctival tissue is recessed to expose limbus. C, Incision is made into anterior chamber for distance of about five clock hours. D, Peripheral iridectomy is done to prevent pupillary block by vitreous gel. E, Cataract is removed with cryoextractor. F, Iris is reposited into eye, and anterior chamber is re-formed. G, Wound is sutured with fine 10–0 nylon sutures. Mayo Clinic Proceedings 1984 59, 622-632DOI: (10.1016/S0025-6196(12)62415-X) Copyright © 1984 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 6 Steps in extracapsular cataract operation. A, Conjunctival tissue is recessed to expose limbus. B, Small incision is made into anterior chamber. C, Anterior capsule is incised with a sharp bent needle. D, Incision is enlarged to five clock hours. E, Nucleus is expressed by pressure at scleral wound transmitted to vitreous gel. F, Residual cortex after anterior capsule and nucleus have been removed. G, Residual cortex is removed with irrigation and aspiration by automated or manual technique. H, Wound is sutured with fine 10-0 nylon sutures. Mayo Clinic Proceedings 1984 59, 622-632DOI: (10.1016/S0025-6196(12)62415-X) Copyright © 1984 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 7 Steps in phacoemulsification. A, Kelman phacoemulsification instrument. B, After conjunctival tissue is recessed, a 2-mm incision is made into anterior chamber. C, Anterior capsule is incised with a sharp bent needle. D, Nucleus is fragmented and aspirated. E, Residual cortex is removed by automated irrigation and aspiration. F, Incision is closed with a few sutures. Mayo Clinic Proceedings 1984 59, 622-632DOI: (10.1016/S0025-6196(12)62415-X) Copyright © 1984 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 8 Diagrams of placement and location of various intraocular lenses in eye. A, Anterior chamber lens resting within anterior chamber angle after intracapsular cataract extraction. B, Iris clip lens fixated on iris and held in place with transiridectomy suture after intracapsular cataract extraction. C, Posterior chamber lens within capsular bag after a planned extracapsular cataract extraction. Mayo Clinic Proceedings 1984 59, 622-632DOI: (10.1016/S0025-6196(12)62415-X) Copyright © 1984 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 9 Photograph of eye of elderly patient with edema of cornea after cataract operation because of damage to corneal endothelium during the procedure. Patient later required a corneal transplant. Mayo Clinic Proceedings 1984 59, 622-632DOI: (10.1016/S0025-6196(12)62415-X) Copyright © 1984 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 10 Fluorescein angiogram of left fundus of a patient 3 months after cataract operation, demonstrating abnormal leakage of dye in a petallike pattern around macula (cystoid macular edema). Mayo Clinic Proceedings 1984 59, 622-632DOI: (10.1016/S0025-6196(12)62415-X) Copyright © 1984 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 11 A, Opacified posterior capsule of a patient 1 year after extracapsular cataract extraction. Patient's vision was severely red patient after undergoing opening of posterior capsule with surgical knife (discission). Mayo Clinic Proceedings 1984 59, 622-632DOI: (10.1016/S0025-6196(12)62415-X) Copyright © 1984 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 12 A, Specular microscopic photograph showing healthy corneal endothelium before cataract removal and placement of intraocular lens. B, Same patient 2 months after a difficult surgical procedure, showing loss of endothelial cells and enlargement of remaining cells to cover areas of loss. Corneal edema is beginning to be evident clinically. (From Bourne WM, Kaufman HE: Endothelial damage associated with intraocular lenses. Am J Ophthalmol 81:482-485, 1976. Published with permission from The American Journal of Ophthalmology, copyright by the Ophthalmic Publishing Company.) Mayo Clinic Proceedings 1984 59, 622-632DOI: (10.1016/S0025-6196(12)62415-X) Copyright © 1984 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 13 Photograph of medallion style iris clip intraocular lens sutured to iris with a 10-0 Prolene suture after intracapsular cataract extraction. Mayo Clinic Proceedings 1984 59, 622-632DOI: (10.1016/S0025-6196(12)62415-X) Copyright © 1984 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 14 Photograph of platinum iris clip intraocular lens after extracapsular cataract extraction. Implant is held in place within remnants of capsular bag and clipped to a haptic behind iris through iridectomy site. Mayo Clinic Proceedings 1984 59, 622-632DOI: (10.1016/S0025-6196(12)62415-X) Copyright © 1984 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 15 Pupillary space of a patient with posterior chamber lens held within capsular bag after planned extracapsular cataract extraction. Posterior capsule has remained clear up to this time. Mayo Clinic Proceedings 1984 59, 622-632DOI: (10.1016/S0025-6196(12)62415-X) Copyright © 1984 Mayo Foundation for Medical Education and Research Terms and Conditions