Phacoemulsification is an outpatient, microincisional cataract surgery procedure which does not require stitches.
An ultrasonic probe is used to fragment the opacified crystalline lens and the resulting material is extracted through a minimum incision using an aspirating system always under the surgeon’s control.
Phacoemulsification’s main advantages over other techniques are:
- No need of stitches
- Less complications in the incision area
- Quicker healing process and faster visual recovery
- Less induced astigmatism
- Anaesthesia: In order to avoid pain and discomfort during surgery, topic anaesthetic eye drops are used, although a sedative is also recommended to facilitate the surgeon’s work.
- Eyeball exposure: A blepharostat is used to hold the eyelids apart so that the areas involved in the surgical procedure are accessible for the surgeon.
- Making incisions: This is one of the main advantages of carrying out cataract surgery using phacoemulsification technique as incision size is reduced. Through the main incision, which is 2.75 to 3.2mm, an ultrasonic probe used to emulsify and suction out the cataract fragments is inserted and through the minor incision or paracentesis, which is 0.8 to 1mm, accessory surgical instruments are inserted.
- Viscoelastic injection: The corneal endothelium is a very fragile structure, which has to be protected from being damaged during cataract surgery. In order to do so, viscoelastic substance is injected before inserting the surgical instruments that will be used to suction out the cataract fragments.
- Capsulorhexis: After making the incisions, the crystalline lens capsule has to be opened so that the opacified nucleus can be extracted through this opening. There are multiple techniques which can be used to carry out this step of cataract surgery, being continuous curvilinear capsulorhexis (CCC) the most widely used due to its multiple advantages which facilitate the stabilization and centering of the intraocular lens.
- Hydrodissection: After capsulorhexis, irrigation of fluid or hydrodissection is performed to gently separate the cortex from the lens capsule.
- Rotation of the nucleus: Once the cortex and the posterior lens capsule have been separated by hydrodissection, the surgeon can rotate the nucleus inside the capsular bag to facilitate its removal using phacoemulsification.
- Nuclear fragmentation and extraction: This is the most characteristic step of phacoemulsification. Using ultrasounds, the crystalline lens is fragmented (emulsified) and aspirated out. The most widely used technique to remove the crystalline lens using phacoemulsification is “divide-and-rule”, as the lens is initially fragmented into 4 quadrants so that they can be separately aspirated out.
- Intraocular lens implantation: When using 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 of stitches after this. If foldable intraocular lens cannot be used (when high myopia or hyperopia coexist) the incision has to be enlarged according to the lens diameter.
Our facility in Valencia
In Clínica Oftalmológica Rahhal, cataract surgery is carried out in our leading, cutting-edge technology facility in Valencia, which allows us to offer the greatest possible guarantees to our patients.