Multiple Methods Technique for Intra-Capsular Cataract Extraction

Abstract

others have noticed that, after the use of alpha-chymotrypsin (Barraquer, 1958) in intra-capsular cataract extraction in patients above 25 years of age, although the lens was easily removed, there was an increased incidence of post-operative complications, including delayed healing of the wound, delayed formation of the anterior chamber, and greater liability to iris prolapse, secondary glaucoma, hyphaema, and striate keratitis. These complications are due to the effect of the enzyme on the corneal and sceral lips of the wound, on the cut ends of the blood vessels, and on the corneal endothelium. The use of the enzyme in intra-capsular lens extraction is not advisable in patients under 20 years of age not only on account of these complications, but because there is great liability of vitreous loss in that the enzyme does not affect the strong hyalo-capsular ligament at that age.To have fewer post-operative complications Arruga (1958), Vail, Schwartz, Schwartz, Sallmann, Maumenee, Troutman, Corwin, and Israel (1960), and others have advised that the enzyme should be used in a concentration of 1:10,000. Barraquer (1961) advised that the enzyme should be quickly washed from the area of the wound and that it should be used for patients over 60 years of age only when the zonule was strong. Paufique (1959) recommended the use of the enzyme only in cases with unusual zonular resistance. Hill and Barraquer (1962) injected under the iris at 6 o'clock two drops of enzyme 1:5000 which was thoroughly washed away after 2 minutes thus giving a limited zonulolysis down to allow an easy tumbling procedure, but it is difficult to understand how 2 drops ofthe enzyme fluid can affect the zonule down without also affecting the rest of the zonule, corneal endothelium, wound edges, and cut ends of blood vessels.Experience of one hundred intra-capsular immature and mature cataract extractions in patients between 30 and 70 years of age using the 2 drops of enzyme at 6 o'clock as a routine before the lens extraction was followed by an increased incidence of post-operative complications as will be described later. The Smith expression method increases the incidence of vitreous loss. The non-toothed capsule forceps or suction-cup method increases the incidence of ruptured lens capsules. The following multiple methods technique uses the advantages and avoids the disadvantages of the various lens extraction techniques and so achieves fewer operative and post-operative complications.