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Phacoemulsification ("phaco") was developed in the search for a way to extract cataracts through a smaller incision. It has become the preferred technique for cataract extraction. An ultrasound  probe is used to break the lens apart without harming the capsule. These fragments are then aspirated out of the eye. A foldable intraocular lens (IOL) is then introduced through the 2.8mm incision. Once inside the eye, the lens unfolds to take position inside the capsule. No sutures are needed, as the incision is self-sealing.

When is the right time for phacoemulsification?

Best results are obtained in persons with early cataracts. It is preferable not to wait until the cataract is ripe and vision is excessively low since the cataract will be to hard for the phacoemulsifier, particularly when the cataracts  are brown [pigmented] as is often the case in Indian eyes. Surgery is indicated as soon as vision is not adequate for daily activities.

What are the advantages of phacoemulsification?

1. Small incision (2.8mm): Sutures are not needed due to the very small incision (it is self-sealing). This reduces the risk of astigmatism and foreign body sensation after surgery. It also eliminates fluctuations in intraocular pressure during surgery, which in turn reduces risk of haemorrhage and retinal damage.

2. Immediate recovery: No admissions to the clinic is needed [not even for insurance/reimbursement purposes]. The patient may restart daily activities immediately.

3. Eye structures are intact: The small size of the incision does not affect eye structure. Eye resistance to trauma is the same as it was before surgery.

What are the risks of phacoemulsification?

Just as any other surgical procedure, phacoemulsification has risks. One out of a hundred persons operated on with this technique has some sort of complication. In almost every case there is a solution to the problem. Severe complications are extremely rare.

How should I prepare for phacoemulsification?

No special preparation is needed for phacoemulsification. Your ophthalmologist should make sure there are no associated pathologies, which can interfere with the prognosis, by making an extensive examination of your eyes including pupil dilation. A measurement of your eye's length [A scan] and corneal curvature is crucial for calculating the power of the intraocular lens to be implanted.

What should I do during surgery?

During surgery you will be lying on the operating bed. The operating microscope will be in front of you. Your face will be covered with sterile drapes. You should never touch these drapes. A small device will hold your lids open. During the procedure you should keep your head as still as possible. You will feel the hands of the surgeon on your forehead and the sound of the phacoemulsifier, similar to that of a hair trimmer. You will occasionally feel cold water over your eye that may even go down your cheek. This is the solution needed to keep your eye properly hydrated.

Is phacoemulsification painful? How long does it take?

Phacoemulsification is performed under local anesthesia and anesthetic eyedrops. No general anesthesia is required. The patient is awake during the procedure feeling no pain at all. Phacoemulsification takes about 10 minutes per eye. Once finished, you will go home without need for hospitalization. If so desired the second eye can undergo surgery the next day.

What should I do after surgery?

Normally there will be some foreign body sensation, similar to having an eyelash in your eye. No prolonged bandages are required and the patient walks out of the operating room by his own means [even though vision will be blurry for 2 or 3 days]. Eyedrops will be prescribed for 3 weeks. One week after surgery you will be able to perform any activity without risk.

What results can I expect?

Over 90% of people achieve a vision better than 6/9 after phacoemulsification. If there is some kind of a retinal condition this may not be the case. Reading glasses are the rule after cataract surgery (in many cases they were also required before surgery due to presbyopia), as the implanted lens has only a single power usually adjusted for comfortable distance vision. In rare cases the lens power is adjusted for near vision in which case glasses would be required for distance vision. Multi focal intra ocular lenses are also available, enabling both distance and near vision without glasses though the quality of vision is never as good as with uni focal lenses. A more recent advance is the "aspheric" intra ocular lens which provides better vision during low levels of illumination, while retaining good vision at other times too.

Can a second procedure be necessary?

There is, in all eyes, a structure called the posterior capsule which serves to support the implanted lens. In some cases this capsule may opacify some time after surgery, compromising vision. In these cases a central perforation in the capsule is required to restore vision [by this time the implanted lens no longer requires this structure for support]. This is called a capsulotomy and is achieved with a YAG laser, painlessly and without any injections in about 5 seconds, as a minor out patient procedure, which provides immediate rehabilitation of vision.