PHACO Surgery for Cataract treatment: Surgeries

Cataract Eye Disease

Phacoemulsification, or phaco, cataract surgery is a procedure in which an ultrasonic device is used to break up and then remove a cloudy lens, or cataract, from the eye to improve vision. The insertion of an intraocular lens (IOL) usually immediately follows phacoemulsification. With advancements in cataract surgery such as the IOL patients can sometimes experience dramatic vision improvement.

Who performs the procedure and where is it performed?
Ophthalmologists (eye surgeon) and optometrists may detect cataracts; however, only an ophthalmologist can perform cataract surgery. An anesthesiologist may be on hand during surgery to administer the local anesthetic. Surgical nurses will assist the ophthalmologist in the operating room and assist the patient preoperatively and postoperatively. The outpatient surgery is performed in a hospital or surgery suite designed for ophthalmic surgery.

Description:
Phacoemulsification is a variation of extracapsular cataract extraction, a procedure in which the lens and the front portion of the capsule are removed. During surgery, the patient will probably breathe through an oxygen tube because it might be difficult to breathe with the draping. The patient's blood pressure and heart rate also are likely to be monitored.

Before making the incision, the surgeon inserts a long needle, usually through the lower eyelid, to anesthetize the area behind the eyeball. The surgeon then puts pressure on the eyeball with his or her hand or a weight to see if there is any bleeding (possibly caused by inserting the anesthetic). The pressure will stop this bleeding. This force also decreases intraocular pressure, which lowers the chances of complications.

After applying the pressure, the surgeon looks through a microscope and makes an incision les than 3 mm on the side of the anesthetized cornea. Once the incision is made, a viscoelastic fluid is injected to reduce shock to the intraocular tissues. The surgeon then makes a microscopic circular incision in the membrane that surrounds the cataract; this part of the procedure is called capsulorhexis. A water stream then frees the cataract from the cortex. The surgeon inserts a small titanium needle, or phaco tip, into the cornea. The ultrasound waves from the phaco tip emulsify the cataract so that it can be removed by suction. The surgeon first focuses on the cataract's central nucleus, which is denser.

While the cataract is being emulsified, the machine simultaneously aspirates the cataract through a small hole in the tip of the phaco probe. The surgeon then removes the cortex of the lens, but leaves the posterior capsule, which is used to support the intraocular lens. The folded IOL is inserted by an injector. The folded IOL means that a larger incision is not required. After the IOL is inserted into the capsular bag, the viscoelastic fluid is removed. No sutures are usually required after the surgery. Some surgeons may recommend that patients wear an eye shield immediately after the surgery.

The entire procedure takes about 10-15 minutes. The phaco procedure itself takes only minutes.

Aftercare:
Immediately following surgery, the patient is monitored in an outpatient recovery area. The patient is advised to rest for 2-3 hours, until he or she returns to the surgeon’s office for follow-up the next day. Usually, over-the-counter medications are advised for pain relief, but patients should check with their doctors to see what is recommended.

There will be some changes in the eye during recovery. Patients may see dark spots, which should disappear a few weeks after surgery. There also might be some discharge and itching of the eye. Patients may use a warm, moist cloth for 15 minutes at a time for relief and to loosen the matter. All matter should be gently cleared away with a tissue, not a fingertip. Pain and sensitivity to light are also experienced after surgery. Some patients may also have slight drooping or bruising of the eye which will improve as the eye heals.

The day after surgery the surgeon will remove the eye shield and prescribe eye drops to prevent infections and control intraocular pressure. These eye drops are used for about a month after surgery. Patients are advised to wear an eye shield while sleeping, and refrain from rubbing the eye for at least two weeks. During that time, the doctor will give the patient special tinted sunglasses or request that he or she wear current prescription eyeglasses to prevent possible eye trauma from accidental rubbing or bumping. Unlike other types of cataract extraction, patients can resume normal activity almost immediately after phaco.

Surgical Alternative:
Some older methods of cataract surgery may have to be used if the cataract is too large to remove with a small incision, including: Extracapsular cataract extraction (ECCE).

While phaco is considered a type of extracapsular extraction, the older version of this technique requires a much larger incision and does not use the phaco machine. It is similar in that the lens and the front portion of the capsule are removed and the back part of the capsule remains. The surgeon might consider this technique if the patient has corneal disease or if the pupil becomes too small during the first stages of surgery.