Phaco cataract surgery. Image © A.D.A.M.

Definition: Phacoemulsification is the most common cataract surgery technique performed. Cataract surgery is used to restore vision in patients whose vision has become cloudy from cataracts, a clouding of the eye's lens.

The lens is located behind the iris. It is responsible for focusing light on the retina, and for producing clear, sharp images. The lens has the ability to change shape, known as accommodation.

 As the eyes age, however, the lens hardens and loses its ability to accommodate. The entire lens is contained within a lens capsule. As the eyes age, oxidative processes occur and dead cells accumulate in the lens capsule, causing the lens to gradually become cloudy. The light that would normally be focused by the lens is scattered around because of the cloudiness, so vision is no longer clear and sharp.

How is phacoemulsification performed?

During phacoemulsification, a surgeon makes a small incision at the edge of the cornea and then creates an opening in the membrane that surrounds the lens. A small ultrasonic probe is then inserted, breaking up the cloudy lens into tiny fragments. The instrument vibrates at ultrasonic speed to chop and almost dissolve the lens material into tiny fragments. The fragments are then suctioned out of the capsule by an attachment on the probe tip. 

After the lens particles are removed, an intraocular lens implant, commonly referred to as an IOL, is implanted and positioned into the lenses natural capsule.

It is inserted through the tiny corneal incision through a hollowed out tube. Once the lens is pushed through, it unfolds and is positioned in place. 

Phacoemulsification is typically performed in an outpatient surgery center and normally does not require a hospital stay. The cataract surgery procedure is performed under local anesthesia (an anesthetic injected around the eye) or topical anesthesia (numbing drops inserted into the eye).

What is the recovery time for phacoemulsification?

The incision made in the cornea usually requires no stitches and is self-sealing. Within a few days, the incision heals completely. Post-operative eye drops are prescribed and usually consist of antibiotics, steroids, and a non-steroidal anti-inflammatory medication. These drops reduce inflammation and prevent infection. The antibiotic is usually discontinued within 7-10 days. The steroid and non-steroidal anti-inflammatory are taped over 3-6 weeks depending on the surgery. Most patients have vision improvement almost immediately and vision tends to steadily improve over 4-5 weeks.

Phacoemulsification revolutionized cataract surgery. Before phacoemulsification was developed, surgeons would remove the entire lens and capsule. This made it difficult to insert an intraocular lens. The lens of the eye contributes a lot of focusing power to the eye.  As a result, if you remove the cataract, which is the lens, the patient is left with a very high "plus," farsighted prescription.

This is why, many years ago, when patients had cataracts removed, they typically wore "cataract glasses."  Cataract glasses were thick, heavy and magnified the eyes. It was not long before surgeons realized that they needed a better process in which to insert a lens implant so that patients would not have to wear such heavy, thick post-cataract surgery glasses. Patients were happy to have the cataract removed, but not so happy that they had to now wear thick, heavy glasses.

Who invented the phacoemulsification procedure?

Dr. Charles D. Kelman, an ophthalmic physician, and surgeon in New York, is credited with developing the initial phacoemulsification process. in the late 1960's and by 1970 the procedure was made available to surgeons. Dr. Kelman worked on many different ideas and designs but got an idea for phacoemulsification after sitting in a dentist chair getting his teeth cleaned by a high-speed ultrasonic cleaner. Interestingly, some of the early ideas he had are showing up again in modern day cataract surgery. 

Also Known As: phaco

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