27/01/2023
The phacoemulsification cataract surgery was developed by an American ophthalmic physician and surgeon, Dr. Charles D. Kelman. This technique was then practiced by surgeons by the end of the 1970s. Nowadays this technique is commonly used by ophthalmic surgeons all around the world.
During the procedure, the corneal incision is self-sealing. It only takes a few days for it to heal entirely. Antibiotics and anti-inflammatory medicines are prescribed by the ophthalmologist in the shape of eye drops that reduce the inflammation and prevent the risks of postoperative infections. In most cases, the antibiotics are prescribed for 7 to 10 days. The anti-inflammatory medication must be taken for 3 to 6 weeks.
Phacoemulsification is a word coming from Greek, “phakos”, which refers to the crystalline lens. It is currently the most popular surgical technique to remove the crystalline lens. Phacoemulsification is also highly appreciated by ophthalmologists worldwide as it is a safe and effective surgery.
During a phacoemulsification, the ophthalmologist starts by opening the capsule with a capsulorhexis forceps by a micro-incision. The clouded lens is then broken up using an ultrasound probe. The broken fragments are removed in the same time by the same probe, before the extracted lens is replaced by a standard lens implant. Phacoemulsification can be performed at any stage of cataract development [1].
[1] Roger F. Steinert, MD - The Basics of Phacoemulsification - CRST - https://crstoday.com/articles/2011-may/the-basics-of-phacoemulsification/
Local anesthesia for phacoemulsification.
Before starting the cataract removal surgery, the surgeon instills anesthetic drops on the eye surface. This is called a “topic anesthesia”.
Ideally, the surgeon performs a small and astigmatically neutral incision near the limbus. Ophthalmologists usually make a clear corneal incision in front of the limbal vascular arcade because of the self-sealing possibility and in order to make the placement of a foldable IOL easier. The standard incision size is 1.8-mm to 2.2-mm wide.
During the cataract surgery, capsulorhexis is done by the surgeon to remove the anterior crystalline tissue using capsulorhexis forceps. A hand-held probe is used to transmit ultrasonic energy with a tip. The tip’s vibration helps the surgeon act against the lens mass. Continuous circular capsulotomy (CCC) is commonly performed by the ophthalmologists during this intervention as it allows them to get a perfect capsular bag that facilitates the IOL implantation [1].
The emulsification of the lens is done using ultrasounds. It is also removed using this instrument, after a fractionation is done by aspiration. To extract the lens, the latter is fractionated into several quadrants, generally four.
Each quadrant is aspirated separately. After that, the nuclear rim and the posterior plate are aspired with an irrigation or an aspiration probe and fractured with lateral pressure.
A probe and a spatula are used to perform the phacosculpture. At the end of this step, an emulsification of each square section is done [2].
Following the phacoemulsification, the posterior capsule remains intact. This helps support the IOL that replaces the clouded lens. Acrylic lenses are the most widely used types of intraocular lens. This is mainly due to their appropriate refractive index [3].
[2] Roger F. Steinert, MD - The Basics of Phacoemulsification - CRST (En ligne) - https://crstoday.com/articles/2011-may/the-basics-of-phacoemulsification/
[3] Cataract surgery steps: from start to finish-Vision and Eye Health (En ligne)- https://www.vision-and-eye-health.com/cataractsurgery-steps.html
Surgeons routinely use cataract removal tools such as forceps, manipulators, hooks, spatulas, and IOL injectors. These are designed for IOL implantation.
To make the procedure easier for the ophthalmic surgeons during a cataract surgery, Moria has designed two cataract phacoemulsification sets : the basic set and the extended set
Numerous scientific studies have shown good outcomes of phacoemulsification on patients 6 weeks after the intervention. Although both small-incision and phacoemulsification are considered safe surgeries, the former procedure shows better results on patients’ eyesight following the intervention [4].
[4] Marta Benítez Martínez,1 David Baeza Moyano,1 and Roberto Alonso González-Lezcano2,* - Phacoemulsification -NIH (En ligne) - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8621996/#:~:text=Phacoemulsification%20can%20be%20used%20at,parameters%20is%20implanted%20%5B8%5D
The major risk of phacoemulsification is a posterior capsule rupture (PCR). This occurs in 0.5% up to 10% of cataract surgeries. In case of a PCR, the vitreous as well as nuclear fragments must be removed from the anterior chamber, from the wound itself or from the vitreous cavity. If this is not done, there are high risks of developing an infection or a vitreous traction that could lead to retinal detachment [5].
[5] Marta Benítez Martínez,1 David Baeza Moyano,1 and Roberto Alonso González-Lezcano2,* - Phacoemulsification: Proposals for Improvement in Its Application - NIH - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8621996/#:~:text=Phacoemulsification%20can%20be%20used%20at,parameters%20is%20implanted%20%5B8%5D
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Last update: 22/04/2024
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