Comparison of phacoemulsification and planned extracapsular extraction.

76% of cataract surgeons in German speaking countries use phacoemulsification (phaco) as the procedure of choice for cataract extraction while the other 24% still use the planned extracapsular extraction (ECCE). The opening technique of the anterior capsule is chosen accordingly: for phaco capsulorhexis is preferred, while for ECCE can opener or letter box technique is usually done. The length of the sclerocorneal incision is 3.2 mm in phaco, 6.2 mm for a PMMA posterior chamber lens implantation and 9-13 mm for the ECCE. We prospectively compared both procedures with each group including 100 consecutive patients. The mean irrigation volume was 96.6 +/- 48.8 ml in the phaco group as opposed to 48.1 +/- 26 ml in the ECCE group. The mean duration of irrigation was 130 +/- 67 s in the first versus 129 +/- 76 s in the second group; mean endothelial cell loss was 7.9 versus 7.1%. No correlation was found between endothelial cell loss and duration of irrigation. Mean postoperative astigmatism measured 1.0 +/- 0.49 in the first group as compared to 3.3 +/- 1.7 dpt in the second group. Except for the astigmatism, our study could not detect significant differences regarding the outcome between both procedures. There are advantages to the phacoemulsification procedure, however, such as a smaller incision (e.g. tunnel technique), a closed irrigation-aspiration system, controlled intraocular pressure and the more frequent use of capsulorhexis. Preferred indications are zonulolysis or previously performed fistulating surgery.