Phacoemulsification - Technique, Advantages, and Indications

Introduction:

Cataracts can significantly affect the perceived image quality, often demanding surgical correction. Phacoemulsification is a blessing for cataract patients in which surgical correction is done innovatively and hassle-free. It is a newer surgical technique in which the foggy eye lens is made into tiny fragments. The broken lens pieces are then flushed out by a special technique, followed by the introduction of artificially made lens into the eye to re-establish the vision.

What Is Phacoemulsification?

Phacoemulsification is an innovative treatment strategy that is extensively carried out for rectifying cataracts, thereby improving the quality of vision and life. It employs certain special techniques to remove the cataractous lens and substitute it with a newer lens.

What Are Cataracts?

• A cataract is an ophthalmic condition in which the eye lens that aids in the vision exhibits fogging. Precipitation of certain proteins present in the lens imparts to its fogging, which often reflects in the form of visual disturbances like faded, dim vision with compromised clarity and color contrast.

• Any irregularity or cloudiness in the lens significantly impacts the vision. Cataracts develop for numerous reasons; however, it often develops as part of aging. Many studies have confirmed the familial influence on cataract formation.

• Certain systemic diseases like diabetes also enhance the likelihood of developing cataracts in the eyes.

• Long-term exposure to harmful rays like ultraviolet and treatment radiation can also induce lens proteins' collapse (break down), giving rise to fogging and cataracts. Prolonged intake of steroid medicines is also seen in association with cataracts.

• There are plenty of cataract subtypes or variants based on the site and extent of the lens opacification.

• Since the trouble is with the lens, the treatment strategies are surgical and more extensive. The routinely performed cataract surgeries include phacoemulsification, extracapsular cataract extraction, and femtosecond laser-assisted cataract surgery.

What Are the Techniques Followed in Phacoemulsification?

Cataracts are corrected by substituting the damaged lens with a new one. Phacoemulsification requires specific machines, techniques, and procedures. The machine typically used for phacoemulsification is known by the name phaco machine.

• Fragmentation of lens: In the phacoemulsification technique, the cloudy lens is subjected to ultrasonic sound waves with the help of an ultrasonic device. These high-frequency waves create an impact on the lens and facilitate fragmentation of the lens. At the same time, the structural backbone of the lens, the capsule, is preserved to enhance the stability of the replacing lens. Fragmented pieces of the lens then give rise to a slimy, emulsified body.

• Irrigation: Phacoemulsification is accompanied by efficient irrigation using sterile liquids that facilitate the pumping out of the mass. The emulsified mass formed by the fragmented lens is then pumped out. In addition, irrigation also helps to tackle the heat that is produced by the ultrasound tip.

• Aspiration: Once the mass is pumped out from the anterior chamber, it is then removed by a technique called aspiration. The vacuum suction principle is employed to draw and engulf the fragmented mass and other debris.

• Intraocular lens (IOL) implantation: After removing all the debris new artificial lens is placed. The artificial lens is usually fabricated in silicone or acrylic, and it mimics that of a normal lens in carrying out its functions.

What Are the Advantages Associated With Phacoemulsification?

Phacoemulsification has several advantages that make them unique and preferable.

• Minimal invasive: Very small surgical opening, which often does not require stitches for closure.

• Fewer complications: As it does not demand an extensive surgical procedure, the complications will also be less. In addition, it is carried out under local anesthesia, anesthetizing only the operating part. Thus the complications from general anesthesia are bypassed.

• Vision correction: All the irregularities in the vision can be corrected as a new lens is placed instead of the faded one.

• Fast healing: Since the surgical wound is remarkably small, healing takes place immediately, enhancing recovery.

• Reduced surgical time: When compared with other surgeries for the correction of cataracts, phacoemulsification can be performed within a short period.

• Lens stability: It ensures remarkable lens stability, which is imparted by the preserved lens capsule.

What Are the Disadvantages Associated With Phacoemulsification?

Though phacoemulsification offers numerous advantages, there are certain disadvantages as well.

• Technique sensitivity: Phacoemulsification is a technique-sensitive surgery and requires skilled and trained ophthalmologists to carry out the procedure. Inadequate training may sometimes lead to corneal injury and other associated complications.

• Expensive: It is quite an expensive surgery and is not affordable for all socioeconomic classes.

• Patient dependence: As the surgery is carried out under local anesthesia, the patient will be awake and aware. So it demands complete cooperation from the patient side.

What Are the Eye Defects for Which Phacoemulsification Is Indicated?

Phacoemulsification is largely advised for the correction of the following eye defects:

• Diminished Visual Acuity: The image becomes unclear and less defined, remarkably affecting the clarity.

• Photophobia: The patient exhibits utmost sensitivity towards high-intensity light.

• Diplopia: Patient experiences double image formation, significantly impairing vision.

• Cortical Cataract: In this type, fogging appears on the rim of the eye lens.

• Nuclear Cataract: Fogging developing over the heart or core of the lens gives rise to nuclear cataracts.

• Posterior Subcapsular Cataract: Back or rear portion of the lens exhibit dullness and opacity.

• Mature Cataract: Opacity extending the entire lens surface without sparing any area gives rise to mature cataracts.

• Brown Cataract: Lens fogginess is contributed by the building up of pigments on the lens.

• Traumatic Cataract: Injury to the eye lens, typically infiltrating and penetrating, often leads to traumatic cataracts.

• Subluxated Cataract: Lens misplacement resulting from trauma may eventually lead to subluxated cataracts.

• Posterior Polar Cataract: It is an inborn variant of cataracts that significantly affects vision.

What Are the Conditions in Which Phacoemulsification Is Contraindicated?

Phacoemulsification is a successful and effective surgical treatment methodology for different types of cataracts. However, it cannot be carried out in all patients. Some of the conditions where phacoemulsification is contraindicated include the following:

• Multiple systemic diseases.

• Acrylic or silicone allergy.

• Parkinson's disease (disease involving the nervous system).

• Uncooperative patient.

• Cushing disease (arising from disparity in cortisol hormone production).

• Coagulopathies (group of diseases reflecting trouble in clotting).

• Poor prognosis.

• Critically ill patients.

Conclusion:

Phacoemulsification is an advanced and innovative surgical approach aimed at the correction of different variants of cataracts. In addition to cataracts, it is also employed for the correction of diplopia and photophobia. It is the most extensively preferred and adopted technique with considerable benefits for patients. When performed by a trained ophthalmologist, phacoemulsification offers promising results, and therefore it always holds an upper hand over other surgical procedures for cataract correction.