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Cataract surgery may be performed to correct vision problems on both eyes. If both eyes are suitable, people are usually advised to consider monovision. This procedure involves inserting an IOL providing near vision into one eye, while using one that provides distance vision for the other eye.
Manual small incision cataract surgery (MSICS) is an evolution of extracapsular cataract extraction (ECCE); the lens is removed from the eye through a self-sealing scleral tunnel wound. A well-constructed scleral tunnel is held closed by internal pressure, is watertight, and does not require suturing.
Couching is the earliest-documented form of cataract surgery, and one of the oldest surgical procedures ever performed. In this technique, the lens is dislodged and pushed aside into the vitreous cavity, but not removed from the eye, thus removing the opacity from the visual axis, but also the ability to focus. [ 10 ]
Phacoemulsification is a cataract surgery method in which the internal lens of the eye which has developed a cataract is emulsified with the tip of an ultrasonic handpiece and aspirated from the eye. Aspirated fluids are replaced with irrigation of balanced salt solution to maintain the volume of the anterior chamber during the procedure.
"Couching for cataract"; Wellcome Collection illustration of Indian doctors performing the technique. Couching is the earliest documented form of cataract surgery. It involves dislodging the lens of the eye, thus removing the cloudiness caused by the cataract. Couching was a precursor to modern cataract surgery and pars plana vitrectomy.
Cataract surgery by phacoemulsification is frequently performed under surface anaesthesia. Facial nerve, which supplies the orbicularis oculi muscle, is blocked in addition for intraocular surgeries. Topical anaesthesia is known to cause endothelial and epithelial toxicity, allergy and surface keratopathy. [citation needed]
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