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 Phacoemulsification

What happens during a phacoemulsification procedure?
What is the recovery from a phacoemulsification procedure?

Phacoemulsification is a modified version of extracapsular cataract extraction (ECCE) and is the most common surgical procedure for removing cataracts. As in other forms of ECCE, phacoemulsification involves removing the eye's natural lens while leaving in place the back of the capsule, which holds the lens in place. The difference with phacoemulsification is that the cataract is broken into tiny pieces that are suctioned from the eye through a smaller incision than that required by other forms of cataract surgery. Healing and rehabilitation are faster with this procedure, and there is little, if any, discomfort.

To understand how the phacoemulsification technique works, it is important to understand what a cataract is and how it interferes with vision. The eye works like a camera with two lenses. The first lens is the cornea, a clear membrane that covers the front of the eye. The second lens is the eye's natural crystalline lens, which is held in place by a capsule located behind the pupil (See Anatomy of the Eye). The cornea is responsible for about 70 percent of the eye's focusing power, while the natural lens fine-tunes the image.

When the natural lens becomes cloudy, usually because of the aging process, it keeps light rays from passing through or diffuses the light in such a way that vision becomes fuzzy or hazy. This cloudy lens is called a cataract. The object of cataract surgery is to remove this hazy lens and to replace it with a plastic prescription lens that is permanently implanted in the eye.

What happens during a phacoemulsification procedure?

In phacoemulsification cataract surgery, the surgeon makes a very small incision -- about 1/8th of an inch -- in the white of the eye near the outer edge of the cornea. A small ultrasonic probe is inserted through this opening and, oscillating at 40,000 cycles per minute, is used to break up (emulsify) the cataract into tiny pieces. The emulsified material is simultaneously suctioned from the eye by the open tip of the same instrument. The hard central core of the cataract (the nucleus) is removed first, followed by extraction of the softer, peripheral cortical fibers that make up the remainder of the lens. The front (anterior) section of the lens capsule is removed along with the fragments of the natural lens. The back (posterior) portion of the capsule is left in place to hold and maintain the correct position for the implanted intraocular lenses.

After removal of the cataract, a prescription intraocular lens, or IOL, is permanently implanted in the lens capsule to replace the natural crystalline lens of the eye that was removed during the surgery. This lens is rolled inside a tiny hollow tube and inserted through the same incision that was used to remove the cataract. The folded lens is pushed out of the tube by a tiny plunger and, as it unfolds, is positioned by the surgeon in the center of the lens capsule. The new lens is held in place by microscopic, spring-like wires that are attached to the implant.

What is the recovery from a phacoemulsification procedure?

The tiny incision made during phacoemulsification surgery generally requires no stitches and heals itself in a few days. Antibiotic and steroid eyedrops may be given to diminish inflammation, to prevent infection, and to keep the eye moistened for several days following surgery.

Phacoemulsification cataract surgery is one of the most effective surgical procedures performed in the United States today, and a large percentage of patients are very satisfied with the results.

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