Decades ago the standard cataract surgery was an intra-capsular cataract extraction. This involved making a large incision, injecting alpha chymotrypsin to dissolve the zonular support, then using a cryo probe to freeze the nucleus and extract it from the eye. An anterior vitrectomy was then performed using either a coaxial vitrector or even with Weck-cel sponges and Wescott scissors. Since the entire lens, including the capsule, was removed, the IOL had to be either fixated to the iris or placed in the anterior chamber with angle support. We have come a long we from that procedure and over the past 25 years, I do not know a surgeon who has performed a routine intra-capsular surgery. This procedure is different: the patient had prior trauma and now has no zonular support. The entire cataract including the capsule will be removed whole through a large scleral tunnel incision. An ACIOL is selected after the anterior vitrectomy is performed and this results in a reasonable visual outcome for the patient.
