Phacoemulsification, often called “Phaco,” is the modern, most frequently used surgical method for removing a cataract, which is a clouding of the eye’s natural lens. This technique is effective, safe, and minimally invasive. It uses high-frequency ultrasound energy to gently break the hardened lens into tiny fragments. These pieces are then suctioned out through a very small incision, allowing for an artificial lens replacement.
Why Phacoemulsification is Necessary
A cataract causes the crystalline lens to become cloudy, scattering light and resulting in blurred vision, faded colors, and difficulty seeing at night. When this clouding interferes with daily activities like driving or reading, surgery is necessary to restore clear sight. Without treatment, the cataract worsens, leading to severe vision loss.
Phacoemulsification has become the standard of care because it represents a significant advancement over older surgical methods, such as extracapsular cataract extraction (ECCE). Traditional ECCE required a much larger incision, typically around 10 millimeters, to remove the entire lens nucleus. Phaco surgery uses a micro-incision, usually only 2 to 3 millimeters wide. This smaller opening allows for a self-sealing wound, resulting in faster recovery, fewer complications, and a lower risk of surgically induced astigmatism.
How the Procedure Works
The procedure begins with anesthesia, typically topical eye drops or a local injection, to numb the eye and ensure comfort. The surgeon creates tiny incisions near the cornea’s edge for access. Through this micro-incision, a specialized instrument creates a circular opening in the anterior lens capsule, known as capsulorhexis. This opening exposes the cataractous lens material while preserving the capsular bag that will support the new lens.
Phacoemulsification involves inserting a thin probe into the lens capsule. This probe emits high-frequency ultrasound waves, vibrating the tip to break up the hard, clouded lens nucleus into small, manageable fragments. Simultaneously, the machine continuously aspirates the fragmented pieces out of the eye using suction. A balanced salt solution is irrigated into the eye to maintain its volume and pressure. Once the nucleus is removed, the softer outer layer, called the cortex, is suctioned out, leaving the clear capsular bag ready for the replacement lens.
Understanding the Intraocular Lens
After the cataract is removed, an artificial device called an Intraocular Lens (IOL) is inserted into the preserved capsular bag to replace the natural lens’s focusing power. This permanent implant is flexible, allowing it to be folded and injected through the small incision, where it unfolds into position. The IOL choice is a significant factor in post-operative vision correction, determining the range of focus the eye will achieve.
The most common type is the Monofocal IOL, which provides clear vision at a single distance, typically set for far vision. Reading glasses are often still necessary for close-up tasks. For patients seeking a wider range of vision, Multifocal IOLs use different zones to allow for clear sight at multiple distances, reducing the dependence on glasses. Toric IOLs are designed for patients with pre-existing astigmatism, correcting the irregular corneal curvature for sharper visual outcomes. The final lens choice depends on the patient’s lifestyle, pre-operative measurements, and visual goals.
Post-Procedure Care and Healing
Recovery following phacoemulsification is generally quick due to the minimally invasive nature of the surgery. Most patients notice an improvement in vision within a few hours to a few days after the procedure, though it may take a few weeks for vision to fully stabilize. Post-operative instructions are provided to ensure proper healing and minimize complications.
Patients are instructed to use prescribed eye drops, which include antibiotics to prevent infection and anti-inflammatory drops to reduce swelling. They must wear a protective eye shield, especially at night for the first week, to prevent accidentally rubbing or pressing the eye while sleeping. Restrictions on activity include avoiding heavy lifting and strenuous exercise for several weeks, as these activities can put undue pressure on the healing eye. Patients should also avoid getting water, soap, or dust directly into the eye and wear sunglasses outdoors to protect against glare and irritants.