Disadvantages of ECCE

1) Large Incision Size

- Requires a 10–12 mm scleral or corneal incision for nucleus delivery.

- Leads to slower wound healing and higher induced astigmatism.

2) Higher Surgically Induced Astigmatism (SIA)

-Large corneoscleral incision significantly alters corneal curvature.

-Reported SIA after ECCE: ~2–4 D, compared with <1 D in phaco.

3) Slower Visual Rehabilitation

-Because of wound size, patients experience delayed stabilization of refraction and visual acuity compared with phacoemulsification

4) Higher Risk of Wound-Related Complications

-Wound dehiscence, iris prolapse, and infection risk (e.g., endophthalmitis) are higher due to larger wound.

5) Greater Dependence on Sutures

-Sutured closure often needed, which can induce irregular astigmatism, suture-related vascularization, or infection

6) Posterior Capsular Opacification (PCO) Rates

PCO remains a problem after ECCE, though it also occurs with phaco. Some studies suggest slightly higher incidence due to less controlled cortical cleanup.

7) Longer Recovery & Return to Activities

-Post-operative recovery time (functional vision, return to daily tasks) is longer compared with phacoemulsification.

8) Less Suitable for High-Volume Surgery Settings

-Longer surgical and recovery time compared with small-incision cataract surgery (SICS) and phacoemulsification, limiting efficiency in high-volume eye care

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Image from Rajan Eye Care Hospital

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