What is Phacoemulsification?
Currently, phacoemulsification, also called “small incision cataract surgery” is the most common type of cataract surgery. Charles D Kelman first introduced phacoemulsification in 1948, and the concept was accepted in 1967. Phacoemulsification utilizes ultrasound energy to emulsify the lens nucleus, vacuum to catch the nuclear material, and irrigation and aspiration for the lens cortex and viscoelastic removal. With recent advances, excellent visual outcomes are achieved. There have been many modifications to the current technique, but phacoemulsification remains the gold standard for cataract extraction.
Key Takeaways
- Phacoemulsification utilizes ultrasound energy for lens irrigation and aspiration.
- Phacoemulsification allows for smaller incisions, more precise outcomes, and fewer complications.
- Phacoemulsification paved the way for a foldable intraocular lens (IOL).
Understanding Phacoemulsification
Phacoemulsification involves the creation of a superior or temporal clear corneal incision of 2-3 mm and two side port incisions at 2-3 clock hours on either side of the main incision. An ultrasonic probe is used to emulsify and aspirate the cataract from the main incision. The creation of small wound areas changed modern surgery as they became self-sealing, astigmatically neutral, with improved-wound strength, and fewer complications.
These developments paved the way for the concept of a foldable intraocular lens (IOL). The foldable IOL can be implanted in the intraocular capsular bag through a smaller incision. The newest techniques use a femtosecond laser-assisted phacoemulsification which cuts more precise corneal incisions, a circular capsulorrhexis, and partial fragmentation of the lens nucleus with less ultrasonic energy release.
Extracapsular surgery is an alternative procedure that requires the surgeon to make a longer incision on the side of the cornea and remove the cloudy core of the lens in one piece, the rest of the lens is removed by suction.
Cataract surgery is performed as an outpatient procedure with an anesthetic placed on the eye. After the natural lens has been removed, it is replaced by an artificial lens, called an IOL.
Indications for Phacoemulsification
Phacoemulsification is indicated when the lens becomes cataractous and reduces the patient’s visual acuity. Individuals may have difficulty performing daily activities, decreased near or distant vision, colored halos, photophobia, monocular diplopia, reduced contrast sensitivity, and in advanced cases, a white reflex in the pupil. Any type of cataract that compromises a patient’s vision is an indication of phacoemulsification.
Examination Prior to Phacoemulsification
A physical examination of the patient must be performed prior to surgery. This includes an assessment of the general physical condition of the patient to rule out systemic comorbidities like diabetes mellitus, hypertension, ischemic heart disease, chronic obstructive pulmonary disease, bleeding diathesis, adrenal suppression, Cushing disease, neurological problems like Alzheimer’s disease, and Parkinson’s disease.
Patients should be asked about any drug sensitivities and if they have a history of anticoagulant and antiplatelet use. The surgeon must also note a history of systemic alpha a1-adrenergic antagonist medications like prazosin, terazosin, and alfuzosin because they are associated with intraoperative floppy iris syndrome during cataract surgery.
An eye doctor will also complete an examination of the front and back of the eye.
Phacoemulsification Complications
The complications of phacoemulsification may occur during surgery or post-surgery.
Intraoperative complications may include:
- Wound leak
- Wound dehiscence
- Wound burn
- Descemet’s membrane detachment
- Corneal burn
- Iridodialysis
- Rhexis extension
- Zonular dialysis
- Posterior capsular tear
- Nuclear drop
- Retained Cortex
- Vitreous prolapse
- Choroidal detachment
- Retinal detachment
Postoperative complications may include:
- Wound leak
- Astigmatism
- Striate Keratopathy
- Corneal edema
- Pupillary block
- Uveitis
- IOL decentration
- IOL tilt
- IOL subluxation
- IOL dislocation
- Vitreous wick syndrome
- Vitreous touch syndrome
- Endophthalmitis
- Toxic anterior segment syndrome
Benefits of Phacoemulsification
Current phacoemulsification techniques have revolutionized cataract surgical outcomes, increasing patient expectations and surgeon expertise and skill. Your eye doctor will help you understand the procedure, the types of intraocular lenses available, and which lens will most benefit you.
