Phacoemulsification


Phacoemulsification

Phacoemulsification refers to modern cataract surgery in which the eye's internal lens is emulsified with an ultrasonic handpiece, and aspirated from the eye. Aspirated fluids are replaced with irrigation of balanced salt solution, thus maintaining the anterior chamber, as well as cooling the handpiece.

Preparation and precautions

The eye is a delicate organ, requiring extreme care before, during and after a surgical procedure. An expert ophthalmologist must identify the need for phacoemulsification and be in charge of conducting the procedure safely. Many university programs allow patients to specify if they want to be operated upon by the consultant or the resident / fellow.

Proper anesthesia is a must for any eye surgery. Topical anesthesia is most commonly employed, using tetracaine eyedrops or lidocaine gel. Alternatively, lidocaine and/or longer-acting marcaine anesthestic may be injected into the area surrounding (peribulbar block) or behind (retrobulbar block) the eye muscle cone to more fully immobilize the extraocular muscles and minimize pain sensation. A facial nerve block using Lidocaine and Bupivacaine may occasionally be performed to reduce lid squeezing. General anesthesia is recommended for children, traumatic eye injuries with cataract, and for very apprehensive or uncooperative patients. Cardiovascular monitoring is preferable in local anesthesia and is mandatory in general anesthesia. Proper sterile precautions are taken to prepare the area for surgery, including use of antiseptics like povidone-iodine. Sterile drapes, gowns and gloves are employed. A plastic sheet with a receptacle helps collect the fluids during phacoemulsification. An eye speculum is inserted to keep the eyelids open.

urgical technique

Before the Phacoemulsification can be performed, one or more incisions are made in the eye to allow the introduction of surgical instruments. The surgeon then removes the anterior face of the capsule that contains the lens inside the eye. Phacoemulsification surgery involves the use of a machine with microprocessor-controlled fluid dynamics. These can be based on peristaltic or venturi type of pump. The phaco probe is an ultrasonic handpiece with a titanium or steel needle. The tip of the needle vibrates at ultrasonic frequency to sculpt and emulsify the cataract while the pump aspirates particles through the tip. In some techniques, a second fine steel instrument called a "chopper" is used from a side port to help with chopping the nucleus into smaller pieces. The cataract is usually broken into two or four pieces and each piece is emulsified and aspirated out with suction. The nucleus emulsification makes it easier to aspirate the particles. After removing all hard central lens nucleus with phacoemulsification, the softer outer lens cortex is removed with suction only. An irrigation-aspiration probe or a bimanual system is used to aspirate out the remaining peripheral cortical matter, while leaving the posterior capsule intact. As with other extracapsular cataract extraction procedures, an intraocular lens implant (IOL), is placed into the remaining lens capsule. For implanting a PMMA IOL, the incision has to be enlarged. For implanting a foldable IOL, the incision does not have to be enlarged. The foldable IOL, made of silicone or acrylic of appropriate power is folded either using a holder/folder, or a proprietary insertion device provided along with the IOL. It is then inserted and placed in the posterior chamber in the capsular bag (in-the-bag implantation). Sometimes, a sulcus implantation may be required because of posterior capsular tears or because of zonulodialysis. Because a smaller incision is required, few or no stitches are needed and the patient's recovery time is usually shorter when using a foldable IOL. [ [http://www.surgeryencyclopedia.com/Pa-St/Phacoemulsification-for-Cataracts.html Surgery Encyclopedia - Phacoemulsification for cataracts] ] [ [http://www.surgeryencyclopedia.com/Ce-Fi/Extracapsular-Cataract-Extraction.html Surgery Encyclopedia - Extracapsular cataract extraction] ] .

History

Charles Kelman introduced phacoemulsification in 1967 after being inspired by his dentist's ultrasonic probe.

References

ee also

*Eye surgery

Resources

* [http://www.clinicareinoso.com/conditns/qx_cat.htm A web site that contains a description and animation illustrating the phacoemulsification process]
* [http://www.phacotraining.com A web site that contains information on Phacoemulsification training]


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Look at other dictionaries:

  • Phacoemulsification — A type of contemporary cataract surgery. Most cataract surgeries today are performed using phacoemulsification, a procedure in which the lens with the cataract is broken up by ultrasound, irrigated, and suctioned out. The word phakos in Greek is… …   Medical dictionary

  • phacoemulsification — /fak oh i mul seuh fi kay sheuhn/, n. Surg. the removal of a cataract by first liquefying the affected lens with ultrasonic vibrations and then extracting it by suction. Also, phakoemulsification. [phaco ( < Gk phako , comb. form of phakós… …   Universalium

  • phacoemulsification — n. (Medicine) surgical removal of the lens of the eye by liquefying it and removing it by suction (method for treating cataracts) …   English contemporary dictionary

  • phacoemulsification — phakoemulsification; n. the use of a high frequency ultrasound probe to break up a cataract so that it can be removed through a very small incision. This is now the most popular method of performing cataract surgery in the developed world …   The new mediacal dictionary

  • phacoemulsification — phac•o•e•mul•si•fi•ca•tion [[t]ˌfæk oʊ ɪˌmʌl sə fɪˈkeɪ ʃən[/t]] n. srg oph the removal of a cataract by first liquefying the affected lens with ultrasonic vibrations and then extracting it by suction • Etymology: 1980–85; phaco (< Gk phako ,… …   From formal English to slang

  • phacoemulsification — noun extracapsular surgery for cataracts in which ultrasonic sound breaks the cortex and nucleus of the lens into small fragments that are then vacuumed away through a small tube • Hypernyms: ↑extracapsular surgery * * * /fak oh i mul seuh fi kay …   Useful english dictionary

  • Факоэмульсификация (Phacoemulsification, Phakoemulsification) — метод раздробления пораженного болезнью хрусталика глаза перед его удалением. Металлический зонд вводится в хрусталик, а затем производится его эмульсификация с помощью высокочастотных ультразвуковых колебаний. В настоящее время данный метод… …   Медицинские термины

  • phakoemulsification — phacoemulsification …   The new mediacal dictionary

  • ФАКОЭМУЛЬСИФИКАЦИЯ — (phacoemulsification, phakoemulsification) метод раздробления пораженного болезнью хрусталика глаза перед его удалением. Металлический зонд вводится в хрусталик, а затем производится его эмульсификация с помощью высокочастотных ультразвуковых… …   Толковый словарь по медицине

  • Cataract surgery — Intervention Cataract in Human Eye Magnified view seen on examination with a slit lamp ICD 9 CM …   Wikipedia


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