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January 11, 1985

Cataract Surgery in Patient Who Sneezes-Reply

Author Affiliations

Northwestern University Medical School Chicago

JAMA. 1985;253(2):202. doi:10.1001/jama.1985.03350260048022

In Reply.—  Drs Gross and Hoffer recommend phacoemulsification cataract extraction for the patient described in the original question. I would agree that an extracapsular extraction is safer for this man, and I would prefer it to an intracapsular procedure. The question as to whether phacoemulsification is safer than a planned extracapsular is somewhat moot. It is true that phacoemulsification can be done through a 3-mm incision, but since we all agree that an intraocular lens is appropriate, the incision would have to be enlarged to 7 mm to insert the lens. Planned extracapsular cataract surgery can be done comfortably through a 10-mm incision. There may be some advantage to an incision 3 mm smaller, but I do not believe this is critical. The essential point is the one with which we all agree—an extracapsular procedure would be safer than intracapsular extraction.As to general anesthesia for this patient, I agree