The modern era of cataract surgery began in 1967, when Charles Kelman invented phacoemulsification. In this procedure, an ultrasonically driven tip is used to emulsify the lens nucleus and remove the fragments with an automated aspiration system. This paradigm shift allowed cataract surgery to be performed via smaller corneal incisions, resulting in a lower incidence of wound-related and vitreous-related complications and more rapid rehabilitation of vision. Although phacoemulsification was initially met with strong resistance, the procedure gained popularity by the 1990s, coinciding with the invention of ophthalmic viscosurgical devices, the evolution of intraocular lens design, and a change to performance of cataract surgery on an outpatient basis. Today, phacoemulsification is the most commonly performed method of cataract extraction in developed areas.
In developing areas, however, the high cost of phacoemulsification technology and its associated disposable equipment have limited its adoption. Instead, extracapsular cataract extraction (ECCE) and manual small-incision cataract surgery (MSICS) remain the most common procedures. The use of historical techniques such as intracapsular cataract extraction (ICCE) and couching are rare. See the Appendix in this volume for further discussion of these techniques.
Excerpted from BCSC 2020-2021 series: Section 11 - Lens and Cataract. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.