During the cataract operation, your surgeon will first remove the clouded lens. (If you are able to have a lens implant, your doctor will perform this procedure right after removing your cataract lens.) There are three methods for removing the clouded lens:
The most common procedure, phacoemulsification requires a smaller incision in the cornea or, less commonly, the sclera. The surgeon uses sound waves (an ultrasonic device) to break the lens into small pieces, and then suctions the tiny pieces out through the same incision.
Next, the doctor will insert the lens into place. Again, the capsular bag will remain to strengthen the eye and to preserve normal architecture. Most IOLs are foldable, so they can be inserted through the same small incision. The lens usually unfolds slowly once it is placed into the capsular bag. The incision can be closed with either one stitch, or usually none at all.
Phacoemulsification, with its smaller incision, offers the fastest healing and recovery time, produces little discomfort, and reduces the chance of uneven focus (astigmatism) or distorted vision.
These procedures are not often used. An extracapsular cataract extraction may be needed if your lens is too hard to phacoemalsify. The extracapsular procedure removes only the inside of the lens but leaves the capsular bag that holds the lens in place. Leaving the capsular bag adds to the structural strength of the eye and promotes easier healing. During the intracapsular procedure, your eye surgeon removes the lens and the entire capsular bag that holds it. Your doctor will make an incision in the sclera, use a special tool to freeze the lens, and then remove it through the incision. He or she may then implant the IOL in front of the iris where its loops hold it in place. Another option is to suture the IOL to the wall of the eye. This latter option enables the IOL to be placed behind the iris.