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  • Writer's pictureAtanas Bogoev M.D. and Maria Cholakova

Extracapsular Cataract Extraction (ECCE) Patient Guide

Cataracts (lens clouding) are inevitable in old age. They lead to lower vision and, if untreated, blindness. Extracapsular cataract extraction is a surgical procedure to remove a cataract. The ECCE procedure is no longer that common. But as one of the conventional methods of cataract surgery, it is useful in severe cases where other methods may not be suitable.

ECCE Procedure Overview

The ECCE cataract surgery is manual, without a laser. Here are the steps of extracapsular cataract extraction:

  • Step 1: Incision. A large incision is made in the cornea or sclera (the white part of the eye) to access the lens.

  • Step 2: Removal of the lens nucleus. The cloudy central part of the lens (the nucleus) is removed in one piece.

  • Step 3: Aspiration of lens cortex. The softer outer layer of the lens (the cortex) is then suctioned out, leaving the clear elastic capsule that surrounds the lens in place.

  • Step 4: Insertion of intraocular lens (IOL). The eye surgeon implants an artificial lens into the remaining capsule to restore vision.

  • Step 5: Closing the incision with sutures.

Advantages of ECCE Surgery

  • Better for very dense cataracts

  • Cost-effective

ECCE is effective for removing very hard cataracts that may not be amenable to other techniques like phacoemulsification. Extracapsular cataract extraction is often less expensive than other methods.

Disadvantages of ECCE Surgery

  • Longer recovery time

  • Larger incision

  • More discomfort

Compared to phacoemulsification, ECCE usually requires a longer recovery period. The larger incision may trigger postoperative discomfort. It also poses a higher risk of complications like eye infection or astigmatism.

Extracapsular Cataract Extraction Indications

ECCE is a great cataract surgery option for patients with:

  • Very dense or mature cataracts

  • Anatomical considerations that make phacoemulsification impractical

  • Limited access to advanced surgical equipment, making it more suitable for use in developing regions

Eye with cataract
An eye with cataract

ECCE Postoperative Care

After ECCE, patients need to follow specific postoperative care instructions, including:

  • Using prescribed eye drops

  • Avoiding heavy lifting or strenuous activities

  • Attending follow-up appointments

Risks and Complications

Like any surgical procedure, extracapsular cataract extraction carries potential risks:

  • Infection (endophthalmitis)

  • Increased intraocular pressure (glaucoma)

  • Retinal detachment

  • Intraoperative or postoperative bleeding

  • Dislocation or improper positioning of the IOL


It may not be a common procedure, but ECCE is a valuable technique for advanced cataract removal. It remains popular in resource-limited settings, and significantly contributes to the reduction of blindness due to cataracts globally.


Checked by Atanas Bogoev, MD.


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