What is Phacoemulsification?

Phacoemulsification is the current method of choice for performing cataract surgery. The whole operation is done through a small incision of less than 3 mm – a marvel of scientific advancement.

Why Phacoemulsification is done?

Cataract is the condition where the natural lens of the eye develops opacity that leads to blurring of vision. When the decrease is vision is problematic enough to cause disturbance in routine life activities, the Phacoemulsification surgery can be performed for visual recovery. In some selected case this may also be done for refractive or presbyopic correction.

Who is a candidate for Phacoemulsification?

Anyone with significant cataract and without any uncontrolled systemic or complicating condition is a suitable candidate. Individuals with systemic conditions like diabetes, high blood pressure or heart disease should first have their systemic disease managed by a concerned specialist before going in for cataract surgery. It is also desirable to get a written clearance and any special instruction from the treating physician.

What are the benefits of Phacoemulsification?

Phacoemulsification leads to rapid recovery of vision and early rehabilitation to normal life. It is a comfortable and convenient surgery. In most situations the patient does not need to stay in the hospital for more than a few hours. There are minimal restrictions or precautions after surgery and routine normal activities can be resumed within a day or so.

What are the risks associated with Phacoemulsification?

Phacoemulsification is a relatively safe surgery for cataract, however, like any other surgery complications can occur in unfortunate circumstances. Many a times these circumstances are beyond human control. Some of the common and important complications are:

• Rupture of posterior capsule
• Prolapse of vitreous requiring vitrectomy
• Haemorrhage (including Expulsive Haemorrhage)
• Dislocation & displacement of lens / nucleus or fragments into vitreous
• Dislocation & displacement of artificial intra-ocular lens
• Inadequate support for lens implantation requiring use of an alternative type of lens implantation or postponing or abandoning lens implant
• Pain & increase the eye pressure or glaucoma post-operatively
• Infection or endophthalmitis which may require injection of antibiotics into the vitreous or even vitrectomy surgery. Although extremely uncommon (about 0.01 – 0.03 %) it is the most dreaded complication. Most cases of endophthalmitis occur because of infecting organisms from the patient’s own body and infrequently by infecting agents present in the fluids used for surgery. There is no way to predict or completely eliminate the risk of this complication. People with diabetes are at greater risk.
• Corneal oedema
• Refractive error and astigmatism
• Wound leak
• Inflammation or uveitis
• TASS or Toxic Anterior segment syndrome
• After-cataract or opacity of posterior capsule may be pre-existing or may develop a few months to years after cataract surgery. This is not really a complication but effect of natural healing process. It can be very easily & safely treated by YAG Laser Capsulotomuy.

What diagnostic lab tests are required for Phacoemulsification?

• Blood Sugar (Fasting & PP)
• Urine (Routine & Microscopy)
• ECG
• Detailed eye examination
• Keratometry (measurement of corneal curvature)
• Ultrasound of the Eye or Biometry (to calculate the power of the lens to be implanted)

How much is the time taken for Phacoemulsification?

Phacoemulsification surgery takes about 5-20 minutes (in most cases about 15 minutes) except in special or difficult circumstance where it may take longer. However, the preparation may take anything between 1-2 hours. It is advisable to observe the patient for about 2 hours after the surgery. So total time spent in the hospital is about 4-6 hours.

What are the precautions & care before Phacoemulsification?

The patient needs to instil some antibiotic eye drops about 4 times a day in both eyes for about 3-5 days before the surgery. Some oral medicines as pre-medication may be required. The eye surgeon decides the type of medicines & dosage. The treatment for any other systemic diseases is to be continued even on the day of surgery except that anti-coagulant or blood thinning medicines may have to be discontinued a few days prior to operation.

What are the precautions & care after Phacoemulsification?

• Avoid head bath for a few days to 1 week
• Avoid rubbing, pressing, massaging, heat, dust, dirt and bright sun for 1 month (use sunglasses outdoors)
• Avoid heavy weights and strenuous physical activity for 1 month
• Avoid swimming and splashing of water on eyes for 1 month
• Continue other treatments advised by other doctors’ e.g. for Diabetes, High Blood Pressure, Asthma, etc.
• Patient can resume most of the normal life activities from the next day

What is the long-term outlook for Phacoemulsification?

Cataract surgery has excellent long-term results. The lens implanted in the eye lasts lifetime (there is no expiry of this lens and it does not need to be replaced except in rare circumstances of any problem). However, some patients may develop thickening / opacity of posterior capsule (a thin membrane on which the lens is placed) that may interfere with vision - this is called After-cataract. This can be easily treated by a short procedure called Nd-YAG Laser Capsulotomy.