It is a cataract-removal surgery that involves removing the front portion of the lens from the eye while retaining the posterior capsule.
This is a safe and painless procedure followed by the implantation of an artificial lens in the affected eye to improve vision.
An ocular cataract is the clouding of the natural lens of the eye, which causes considerable loss of vision, especially in people over 40 years of age.
There are several types of cataracts, classified according to the eye area where it occurs.
Clouding at the back of the lens is called a subscapular cataract, while cloudiness at the core of the lens is called a nuclear cataract.
On the other hand, a cortical cataract begins at the periphery of the lens and spreads toward the center.
Cataract formation is related to aging, although more and more people are suffering from cataracts due to diseases and other medical conditions.
Cataract patients are recommended to undergo phacoemulsification, especially those who need to maintain good visual acuity to drive, fly, or operate machinery and equipment.
Advantages of phacoemulsification
The procedure is safe and can be done in patients of all ages, including babies with congenital cataracts and the elderly.
Patients at increased risk of developing cataracts may also consider the phacoemulsification procedure.
These include diabetic, hypertensive, and obese patients and those who experienced injuries and trauma to the eye that caused cloudy or hazy vision.
Phacoemulsification has a high success rate, as patients report better vision and perceive color and depth more accurately after the procedure.
Phacoemulsification is an outpatient microincision cataract surgery procedure that does not require stitches.
An ultrasonic probe is used to fragment the opacified crystalline lens, and the resulting material is extracted through a minimal incision using a suction system always under the control of the surgeon.
There are fewer complications in the incision area, and the healing process is faster and visual recovery faster.
Before the procedure, the patient undergoes a comprehensive eye exam in which the ophthalmologist uses an ultrasound or laser scanning device to examine the affected eye thoroughly.
The tests are intended to determine the best intraocular lens for the patient.
To avoid pain and discomfort during surgery, anesthetic eye drops are used, although a sedative is also recommended to facilitate the surgeon’s work.
Phacoemulsification is an outpatient procedure performed under local anesthesia for adult patients or under general anesthesia for pediatric patients.
Exposure to the eyeball
Blepharospasm is used to keep the eyelids apart so that the surgeon can access the areas involved in the surgical procedure comfortably and free of the risk of the eyelids close.
With the help of a microscope, the surgeon makes a small incision in the eye next to the cornea.
Through the main incision, which is usually 2.75 to 3.2 mm, an ultrasonic probe used to emulsify and suction the cataract fragments is inserted and, through the minor incision or paracentesis.
The other incision is 0.8 to 1 mm, where auxiliary surgical instruments are also inserted.
To do this, a viscoelastic substance is injected before the surgical instruments that will be used to suction out the cataract fragments are inserted.
The viscoelastic fluid cushions the intraocular tissue and reduces shock.
Another incision is made in the membrane surrounding the cataract so that it can be easily separated from the cortex using a stream of water.
After making the incisions, the crystalline lens capsule must be opened so that the opacified nucleus can be removed through this opening.
Multiple techniques can be used to carry out this stage of cataract surgery. Continuous curvilinear capsulorhexis is the most widely used due to its numerous advantages that facilitate stabilization and centering of the intraocular lens.
Following capsulorhexis, fluid irrigation or hydrodissection is performed gently to separate the lens capsule’s cortex.
Once the posterior lens cortex and capsule have been hydrodissected, the surgeon can rotate the nucleus within the capsular bag to facilitate removal by phacoemulsification.
Fragmentation and nuclear extraction
With the support of ultrasound, the crystalline lens is fragmented (emulsified) and aspirated for cleaning the area.
A titanium needle called a phaco probe is inserted into the cornea and directed to the central nucleus of the cataract, where it is densest.
This device oscillates at high speed to break the cataract into tiny pieces, which are then suctioned out through a small hole at the tip of the tube.
As the central nucleus of the cataract is emulsified and removed, the probe moves to the peripheral part of the lens, and the front part of the lens capsule is removed, as well as part of the natural lens.
The most commonly used technique to remove the crystalline lens by phacoemulsification is the “split and ruler” since the lens is initially fragmented into four quadrants so that they can be aspirated separately.
Intraocular lens implant
After cleaning the fragments, an intraocular lens is implanted in the capsule bag.
When using a foldable intraocular lens, a special injector is used to deliver the lens through the same incision used for phacoemulsification, which will unfold once inside the capsular bag, with no need for stitches after this.
This permanent implant replaces the front part of the natural lens, while the remaining back part of the lens keeps the inserted lens in place.
If a foldable intraocular lens cannot be used, which occurs when high myopia or hyperopia coexist, the incision should be enlarged according to the diameter of the lens.
The viscoelastic fluid introduced at the beginning of the procedure is then withdrawn.
Phacoemulsification can also be performed with the use of laser technology.
This method involves using a specialized machine that makes the incision and smooths the cataract so that it can be easily removed.
The procedure follows the same method as traditional phacoemulsification, but because laser technology is used instead of a knife, it offers a faster recovery time and is more accurate.
Depending on the technique used, the incisions can be closed with tiny stitches, or a self-sealing method is performed.
Patients receiving stitches are scheduled for a follow-up to remove the stitches.
The surgery takes about an hour and can only be done on one eye at a time.
Patients with cataracts in both eyes are generally scheduled for cataract removal sessions two weeks apart.
Possible risks and complications of phacoemulsification
According to studies, one in 10 patients develops complications from phacoemulsification, and the risk is higher in those who have other eye diseases and cataracts.
Among the risks and complications that come with the procedure are:
- Adverse reactions to anesthesia and bleeding.
- Endophthalmitis, or inflammation of the inner parts of the eyeball.
- Retinal detachment.
- Itchy sensation in the eye.
- Ocular discharge
- Cataract recurrence, with the condition developing from the remaining posterior part of the lens capsule.
- Glaucoma: In some rare cases, glaucoma can develop after phacoemulsification, leading to total blindness.
- Corneal edema or swelling of the transparent covering of the eye.
After surgery, patients may see dark spots that should disappear after several weeks.