Phacoemulsification of a cataract

Phacoemulsification of a cataract

Samia Nawaz, John Chancellor, and Ahmed Sallam


A cataract can be simply defined as clouding of the lens of the eye. As the proteins that make up the lens of the eye harden and aggregate, a cataract forms. Cataracts are attributed to cause half of vision loss in the population and are most commonly related to age, although trauma, radiation exposure, and genetics have also been implicated. Cataracts can cause visual disturbance such as faded color perception, blurry vision, reduced night vision, and the perception of seeing halos around lights. Due to these hindrances, surgery is a common approach to alleviate the problems they cause. Phacoemulsification is a technique that uses ultrasonic waves to emulsify the dysfunctional lens, and we may then replace it with a synthetic one, clarifying vision. A 55 year old patient presented with reduced visual acuity due to a cataract in their left eye. A phacoemulsification of the cataract with implantation of an intraocular lens was performed here.


First, the patient’s eye was anesthetized using topical anesthetic. The patient was prepped and draped using sterile technique.  A knife was then inserted into the cornea 90 degrees to the presumed incision site. This is known as the primary port incision. After this, incisions are placed 45 degrees to the presumed incision site, known as the secondary port incision. Viscoelastic was then inserted into the anterior chamber. Continuous curvilinear capsulorrhexis was performed using capsulorrhexis forceps to open the anterior capsule of the eye. We began with a central linear cut, then pulled the needle in the direction of the desired tear, allowing the capsule to fold over. We had created a flap we used to gain entry to the lens. We injected salt solution under the anterior capsule in a step called hydrodissection, allowing the fluid to decompress the anterior capsule by compressing the central part of the lens. Nuclear rotation, a step which mobilizes the nucleus and minimizes the possibility of damage to the zonular fibers or posterior capsule, was then performed. Phacoemulsification was begun after this, where ultrasonic waves broke up the nucleus of the lens into smaller pieces, thereby fragmenting the cataract and emulsifying it into a mixture to be irrigated and aspirated. We then inserted an irrigation/aspiration instrument to remove residual pieces of lens cortex. The last step was insertion of the pre-folded synthetic lens. We reformed the anterior chamber with viscoelastic, and then loaded the lens in with a cartridge. It will unfold and settle into the eye with our adjustments. We then irrigated the wound to decrease leakage by swelling up the wound edges.


The patient was discharged the same day and followed up in clinic 1 week later. The incisions were healing well with no indications of infection or wound dehiscence.


Phacoemulsification of a cataract is a successful and widely used way of alleviating reduced visual acuity as a result of cataract formation in the eye.

Phacoemulsification of a cataract
Indications for cataract surgery namely involve the patient’s desire to improve their vision. Symptoms of cataracts include reduced visual acuity, glare, line distortion, and altered color. Severe cataracts in adults or children can sometimes make the pupil appear white.
Contraindications for cataract surgery include low endothelial cell count.
The operation was performed with topical anesthesia, patient in the temporal position.
A detailed history is taken from each patient undergoing phacoemulsification of a cataract to elicit what type of visual disturbance he/she is experiencing. Additionally, an abnormally dim, absent or irregular red reflex will be elicited on funduscopic exam, as well as reduced visual acuity using the Snellen test. A dilated slit-lamp eye examination can also show us the exact positioning of the cataract.
One of the advantages of cataract surgery is that it is a fairly quick procedure with same-day discharge. Visual acuity is quickly improved. Disadvantages include the risk of complications, as discussed below.
Cataract surgery is a fairly low-risk procedure, but as with all surgical procedures, there is the risk of bleeding. Despite sterile setup, there is also the risk of eye infection, which is very small. Other postoperative risks include retinal detachment.

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