Extracapsular cataract extraction (ECCE) is a surgical technique that was monumental in the development of modern cataract surgery prior to phacoemulsification. It was once the most common type of cataract surgery for removing the crystalline lens and remains the preferred choice in many countries for the surgical management of many types of cataracts. ECCE consists of removing the central anterior lens capsule, extracting the lens nucleus and cortex whole, and leaving intact the peripheral anterior lens capsule, posterior capsule, and the attachment of zonules. Mastering this surgical technique to manage cataracts remains very important in present-day ophthalmic practice as it allows the completion of cataract surgeries when phacoemulsification is unavailable or contraindicated, such as in severe endothelial dystrophy or a hard cataract (Pershing S, Kumar A. Phacoemulsification versus extracapsular cataract extraction: where do we stand? Curr Opin Ophthalmol 22(1):37. https://doi.org/10.1097/ICU.0b013e3283414fb3 , 2011). In these situations, extracapsular cataract extraction has a low rate of complications and is less likely to cause corneal decompensation or posterior capsule rupture. For these reasons, residents and surgeons need to learn this technique and perform it when necessary. We include in this chapter step-by-step instructions for the classic ECCE procedure using a 10.5 mm incision, a list of instruments, common complications, and intraoperative management (Hausheer JR, ed. Basic techniques of ophthalmic surgery, 3rd ed. American Academy of Ophthalmology, 2019).