Surgical modalities

Surgical modalities

The most commonly used technique in cataract surgery in the United States is phacoemulsification, which is traditionally performed using ultrasound technology.

Extracapsular cataract extraction (ECCE) is performed in the US on mature lenses by making a large incision. This technique is also used in developing countries where phacoemulsification equipment is not always readily available. A newer variation of ECCE, manual small incision cataract surgery (MSICS), allows for smaller incision sites and is now often performed in the US.


Small incision

Entire lens is fragmented using ultrasound

Incision site usually self-seals

Faster recovery time

Fewer complications


Large incision

Lens removal in one piece

Requires sutures

Longer recovery time

Lower cost of equipment


Femtosecond laser assisted cataract surgery (FLACS) was approved for phacoemulsification in 2010 in the US. This approach was designed to decrease surgeon-to-surgeon variability and increase accuracy and safety of corneal incision, capsulotomies, and lens fragmentation. Recent reviews concluded there is currently little difference in outcomes between FLACS or standard ultrasound phacoemulsification. One review reported overall low levels of evidence but no apparent difference in terms of overall operating time, complications, frequency of capsule tears, and visual outcome. FLACS produced more predictable capsulotomy diameters, decreased average central corneal thickness after surgery, shortened phacoemulsification time but not overall surgical time, and generated more horizontally centered IOLs (by approximately 128.84 um).