Phacoemulsification with indocyanine green versus manual expression extracapsular cataract extraction for advanced cataract

J Cataract Refract Surg. 2002 Dec;28(12):2165-9. doi: 10.1016/s0886-3350(02)01359-7.


Purpose: To compare the outcomes of indocyanine green dye (ICG)-assisted phacoemulsification with manual expression extracapsular cataract extraction (ECCE) in eyes with advanced cataract.

Setting: Parkland Memorial Hospital and Dallas Veterans Affairs Medical Center, Dallas, Texas, USA.

Methods: In this retrospective study, 72 consecutive cases of advanced or mature cataract extractions performed in a 1-year period were reviewed. Fifty-nine eyes met the inclusion and exclusion criteria; 33 had ICG-assisted phacoemulsification and 26, manual expression ECCE. Preoperative and intraoperative findings and the postoperative outcomes up to 6 months were analyzed.

Results: Intraoperative complications included posterior capsule tear with vitreous prolapse in 2 eyes (6.6%) and conversion to manual expression ECCE in 1 eye (3.3%) in the ICG phacoemulsification group. There was no intraoperative complication in the manual expression ECCE group. There were significantly more patients with a best corrected visual acuity of 20/30 or better in the ICG phacoemulsification group than in the manual expression ECCE group at all postoperative periods. The mean logMAR visual acuities were significantly better in the ICG phacoemulsification group at all postoperative intervals. The ICG phacoemulsification group had significantly less postoperative astigmatism. There was no significant difference between the groups in the early postoperative intraocular pressure.

Conclusions: Phacoemulsification with ICG led to better postoperative visual acuity and less postoperative astigmatism than manual expression ECCE. Phacoemulsification with ICG was associated with more intraoperative complications than manual expression ECCE; however, the complication rate is comparable to a previously published rate for phacoemulsification performed in a university training program. Phacoemulsification with ICG appears to be a reasonable alternative to manual expression ECCE for advanced cataract.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Cataract / diagnosis*
  • Cataract Extraction / methods
  • Coloring Agents*
  • Female
  • Humans
  • Indocyanine Green*
  • Intraoperative Complications
  • Lens Capsule, Crystalline / pathology*
  • Lens Capsule, Crystalline / surgery
  • Male
  • Middle Aged
  • Phacoemulsification / methods*
  • Postoperative Complications
  • Retrospective Studies
  • Staining and Labeling / methods
  • Visual Acuity


  • Coloring Agents
  • Indocyanine Green