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| Phacoemusification |
| What is Phacoemulsification? |
Phacoemulsification ( Phaco = lens, emulsification) or phaco as it is popularly called is a technique where the lens is broken into small pieces , emulsified and then aspirated.
The ultrasound energy is used to emulsify the cataract. A handpiece with quartz crystals is used to produce the ultrasonic energy which moves the tip of 0.9 to 1.4 mm size back and forth to hit and emulsify the cataract.
The whole procedure is performed through an incision size of 3.2 mm in the form of a self sealing tunnel which does not require any stitches for its closure. The "phaco probe" has both irrigation and aspiration through the 3.2 mm and a continuous flow of a balanced fluid goes into the eye and is aspirated out along with emulsified pieces of cataract.
The lens has a nucleus in the center, surrounded by epinucleus and then cortex with "capsule" around it and a continuous round hole of approximately 5-6mm (the CCC or Continuous curvilinear CAPSULORRHEXIS) is made so that the phaco tip can directly come into contact with the nucleus to emulsify it.
Phacoemulsification has gained in popularity in recent years, and is now the preferred form of cataract removal. Although this procedure has been available to us for a long time, recent advances and refinements in machine and microsurgical instruments have made it safer and more effective than previously.
The technique of phacoemulsification utilizes a small incision. The tip of the instrument is introduced into the eye through this small incision. Localized high frequency waves are generated through this tip to break the cataract into very minute fragments and pieces, which are then sucked out through the same tip in a controlled manner. A thin 'capsule' or shell is left behind after cleaning up of the entire opaque cataract.
The incision size for phacoemulsification is approximately 3.0 millimeters in width. If a lens implant that can be folded is used following removal of the cataract, this incision may not have to be enlarged. If a lens is used which cannot be folded, the incision must be enlarged to 5.0 or 5.5 mm.
Implantable Contact Lens (ICL)
The incision (wound) required for phacoemulsification is small (3 mm) and the wound construction is such that it is self-sealing. Therefore a surgery in which a foldable lens has been implanted through the small 3 mm wound, generally does not require any stitch, as it is watertight. The surgeries in which the wound has been enlarged (5 or 5.5 mm) to put a lens that can not be folded, is likely to require one stitch, because the wound is larger.
In addition, some surgeons simply prefer the safety of having the incision sutured, even if the incision is already watertight. The best procedure for a patient is usually the one with which his or her ophthalmologist feels the most comfortable, since these variations of cataract surgery are all quite effective.
Eye- Drop Anaesthesia For Phaco
Anaesthetic eye drops are used prior to the procedure to numb the eye. Sometimes a diluted 1% lidocaine is irrigated into the anterior part of the eye to numb the sensitive iris in case the phaco tip touches it.
Since phaco is a short time painless procedure and there is very little handling of the eye, this no-injection eye drop anaesthesia is enough for a total comfort of the patient.
One should also remember that eye drop anaesthesia is safer than injection which can cause complications like drug reaction and peforation of the eye.
The No-Stitch Phaco
Phacoemulsification is done with a thin probe which can enter the eye through a 3.2 mm incision. This incision is made in such a manner that a small tunnel is formed with a length of approximately 2.5 mm. The configuration of the tunnel is such that it closes when the eye pressure is increased and so does not need any stitch to keep it closed.
Best Time For Phaco Cataract Surgery
Today the life style of every person is such that eyes are used extensively for reading/writing/driving during day and night/ watching television etc. and cataract surgery has become very patient friendly. The recovery is quick and discomfort is minimal. Also as the cataract "matures" , it becomes harder and difficult to emulsify with phacoemulsification.
It is therefore, advisable to get the phco-cataract surgery done as early as possible. Definitely when the person is able to read the top letter indicating cataract is sufficiently ready for operation.
Precautions Before & After Phaco Cataract Surgery
It is advisable to maintain proper hygiene and cleanliness. No cosmetics should be used on the eye or face. There are no dietary restrictions required before or after cataract operation. Dietary restrictions for other systemic diseases should be observed.
Splashing water in the eye to wash it is not to be done. Face can be washed and head bath can be taken with the eyes closed.
Phaco Cataract Surgery In Diabetics
Control of blood sugar is essential. A post prandial blood sugar level of up to 180 mg % should be maintained before and after cataract operation.
Phaco Cataract Surgery In High Blood Pressure
Blood pressure control should be maintained with appropriate medications before/ during and after surgery.
Phaco Cataract Surgery In Other Diseases
Other diseases like Bronchial Asthma, Rheumatoid Arthritis, Dependance on steroids should be discussed and appropriate measures should be taken.
The Cold Phaco
New phacoemulsification probe produce less heat during ultrasonic vibration thus prteventing heat induced damage to the incision and cornea. This can even be used without infusion sleeve through a smaller incision of 1 – 1.4 mm.
Micro- Incision Cataract Surgery (MICS)
Phacoemulsification through a smaller incision of around 1 mm with a sleeveless phaco tip and irrigation through a separate side port provides an advantage of speedy recovery, faster healing and lesser surgery induced astigmatism. The surgery involves insertion of a rollable lens of 5.5mm dia which can be inserted through 1.2 mm incision (The microincision).
SPECIAL LENSES
Multi-Focal IOL
Accomodative IOL
Rollable IOL
Blue Blocking IOL
Light Adjustable IOL
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