What Is Phacoemulsification?

Phacoemulsification is a surgery used to restore vision in people with cataracts, or clouding of the eye's lens. This type of cataract surgery uses ultrasonic waves to break the lens into tiny pieces, which are then suctioned out of the eye with a vacuum. The procedure is completed by replacing the damaged lens with an artificial one.

This article discusses how phacoemulsification is performed, what to expect, and how long it takes to recover.

This photo contains content that some people may find graphic or disturbing.

See Photo

Overview of Phacoemulsification

During phacoemulsification, the lens of the eye is first exposed from within its surrounding capsule. High-frequency sound waves emitted by a handheld ultrasound device then break up the lens into an emulsified gelatinous mass. The mass is finally flushed with sterile fluids (irrigation) and suctioned out of the eye with a vacuum (aspiration).

Phacoemulsification is performed with a sophisticated device referred to as a phaco machine. It consists of a handpiece, foot pedal, irrigation and aspiration system, and a variety of tips bent at different angles to accurately deliver the ultrasonic energy.

Phacoemulsification vs. Other Cataract Surgeries

Phacoemulsification is one of three major types of surgery used to treat cataracts. The others are:

• Femtosecond laser-assisted cataract surgery (FLACS): A procedure introduced in 2009 that uses a laser to cut the cornea and remove the lens
• Extracapsular cataract extraction (ECCE): An older procedure that uses a scalpel to cut the cornea and remove the lens

Before phacoemulsification was pioneered in the 1960s, surgeons would remove the entire lens and capsule, making it difficult to accurately insert the replacement lens. As a result, most people were forced to wear thick, heavy eyeglasses to correct their farsightedness.

With phacoemulsification, this was no longer so. In most cases, vision is immediately corrected and the replacement lens becomes a permanent, stable part of the eye.

Phacoemulsification is by far the most common type of cataract surgery performed in the developed world, although FLACS is increasingly being adopted by ophthalmologic surgeons.

This doesn't mean that phacoemulsification is the one-size-fits-all solution. For some older adults, ECCE may be a reasonable option if the lens cannot be broken up by high-frequency sound waves or the lens was damaged through a traumatic injury. ECCE also tends to be less expensive.

Similarly, FLACs may be better suited to treat certain advanced or complicated cataracts as the procedure is generally more precise.

Preparing for Phacoemulsification

Phacoemulsification is an increasingly common surgery performed in an operating room with sterile drapes, gowns, and gloves. It generally takes 10 to 20 minutes to complete, not including recovery time. Phacoemulsification is performed on an outpatient basis.

Depending on your age, the severity of your cataracts, and other factors, one or more anesthetics may be used to lessen pain and discomfort. Options include:

• Topical anesthesia, such as lidocaine, applied directly to the eye (most common)
• Anesthetic eye blocks, such as Marcaine (bupivacaine), injected into the eye
• Facial nerve blocks, using Marcaine and lidocaine, to prevent eyelid movement
• General anesthesia for children, people with traumatic eye injuries, or those who are distressed

Once the anesthesia is delivered and begins to take effect, you are laid on a plastic-covered operating table, and your eyelid is held open with a device known as an eye speculum.

Phacoemulsification Steps

Phacoemulsification can vary from one person to the next, but it tends to follow the same steps irrespective of a person's age or the severity of their condition:

1. The surgeon makes one or two or two small incisions at the edge of the cornea.
2. The surgeon then creates an opening in the membrane that surrounds the lens.
3. Saline is injected into the capsule to separate the lens from the surrounding capsule.
4. The surgeon breaks up the lens with a series of ultrasonic tips that pulse (oscillate) at different speeds. The rate of oscillation is controlled by the foot pedal.
5. As the lens fibers are broken up, which surgeons refer to as "chopping," the irrigation and aspiration system simultaneously suctions out the debris.
6. A replacement lens made of silicone or acrylic—called an intraocular lens implant (IOL)—is then inserted into the capsule to replace the damaged lens.
7. Because the incision is smaller than traditional cataract surgeries, few or no stitches may be needed.
   

Recovery: What to Expect

After the surgery, you will be wheeled to a recovery room and monitored until the effects of the anesthesia have worn off (usually within 30 minutes). Once you are given the OK to leave, a friend or family member should drive you home as your vision will likely be cloudy for a while.

When you arrive home, take it easy and rest as much as you can. If you see popped blood vessels or bruising around your eye, rest assured that these side effects are normal and should fade within a few days.

Once you are rested, you can watch TV in moderation, shower or bathe, and work on the computer. Avoid swimming pools and hot tubs for at least a week. You should also avoid cooking during the same timeframe to prevent getting any grease, aerosolized oils, or splatters in your eyes.

For the next few weeks, avoid any activities that can get dust, dirt, or grit in your eyes (such as mowing the lawn). If you have to go out on a windy day, put on eyewear that covers as much of the eye as possible, including the sides.

If your surgeon prescribed antibiotic eye drops, take them to completion even if your vision is good and your eyes seem perfectly normal. Most antibiotic eye drops are prescribed for seven to 10 days.