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Phacoemulsification
 
 
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Phacoemulsification refers to modern cataract surgery
Cataract surgery

Cataract surgery is the removal of the lens of the eye that has developed an opacification, which is referred to as a cataract. Metabolic changes of the crystalline lens fibers over the time lead to the development of the cataract and loss of transparency, causing impairment or loss of vision....
 in which the eye
Eye

Eyes are Organ that detect light, and send signals along the optic nerve to the visual system and other areas of the brain. Complex optical systems with resolving power have come in ten fundamentally different forms, and 96% of animal species possess a complex optical system....
's internal lens
Lens (anatomy)

The lens is a transparent, Lens_#Types_of_lenses structure in the eye that, along with the cornea, helps to refract light to be Focus on the retina....
 is emulsified with an ultrasonic
Ultrasound

Ultrasound is cyclic sound pressure with a frequency greater than the upper limit of human hearing . Although this limit varies from person to person, it is approximately 20 Hertz in healthy, young adults and thus, 20 kHz serves as a useful lower limit in describing ultrasound....
 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.

eye is a delicate organ, requiring extreme care before, during and after a surgical procedure.






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Cataract Surgery
Phacoemulsification refers to modern cataract surgery
Cataract surgery

Cataract surgery is the removal of the lens of the eye that has developed an opacification, which is referred to as a cataract. Metabolic changes of the crystalline lens fibers over the time lead to the development of the cataract and loss of transparency, causing impairment or loss of vision....
 in which the eye
Eye

Eyes are Organ that detect light, and send signals along the optic nerve to the visual system and other areas of the brain. Complex optical systems with resolving power have come in ten fundamentally different forms, and 96% of animal species possess a complex optical system....
's internal lens
Lens (anatomy)

The lens is a transparent, Lens_#Types_of_lenses structure in the eye that, along with the cornea, helps to refract light to be Focus on the retina....
 is emulsified with an ultrasonic
Ultrasound

Ultrasound is cyclic sound pressure with a frequency greater than the upper limit of human hearing . Although this limit varies from person to person, it is approximately 20 Hertz in healthy, young adults and thus, 20 kHz serves as a useful lower limit in describing ultrasound....
 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
Cataract

A cataract is a clouding that develops in the lens of the eye or in its envelope, varying in degree from slight to complete Opacity and obstructing the passage of light....
 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
Tetracaine

Tetracaine is a potent local anesthetic of the ester group. It is mainly used topical anesthetic, in ophthalmology and as an antipruritic, and has been used in spinal anesthesia....
 eyedrops or lidocaine
Lidocaine

Lidocaine or lignocaine is a common local anesthetic and antiarrhythmic agent drug. Lidocaine is used topically to relieve itching, burning and pain from skin inflammations, injected as a dental anesthetic, and in minor surgery....
 gel. Alternatively, lidocaine and/or longer-acting marcaine anesthestic may be injected into the area surrounding (peribulbar block) or behind (retrobulbar block
Retrobulbar block

A retrobulbar block is a regional anaesthesia nerve block into the retrobulbar space, the area located behind the globe of the eye. Injection of local anesthetic into this space constitutes the retrobulbar block....
) the eye muscle cone to more fully immobilize the extraocular muscles and minimize pain sensation. A facial nerve block using Lidocaine
Lidocaine

Lidocaine or lignocaine is a common local anesthetic and antiarrhythmic agent drug. Lidocaine is used topically to relieve itching, burning and pain from skin inflammations, injected as a dental anesthetic, and in minor surgery....
 and Bupivacaine
Bupivacaine

Bupivacaine is a local anaesthetic drug belonging to the amino amide group. AstraZeneca commonly markets it under various trade names, including Marcain, Marcaine, Sensorcaine and Vivacaine....
 may occasionally be performed to reduce lid squeezing. General anesthesia is recommended for children, traumatic eye injuries with cataract, for very apprehensive or uncooperative patients and animals. Cardiovascular monitoring is preferable in local anesthesia
Local anesthesia

Local anesthesia is any technique to render part of the body insensitive to pain without affecting consciousness. It allows patients to undergo surgical and dentistry procedures with reduced pain and distress....
 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.

Surgical 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
Fluid dynamics

In physics, fluid dynamics is the sub-discipline of fluid mechanics dealing with fluid flow — the natural science of fluids in motion....
. 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
Cataract

A cataract is a clouding that develops in the lens of the eye or in its envelope, varying in degree from slight to complete Opacity and obstructing the passage of light....
 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
Intraocular lens

An intraocular lens is an implanted lens in the eye, usually replacing the existing lens because it has been clouded over by a cataract, or as a form of refractive surgery to change the eye's optical power....
 (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. .

History

Charles Kelman
Charles Kelman

Charles D. Kelman was an ophthalmologist and a pioneer in cataract surgery.Kelman was born in Brooklyn, New York to David and Eva Kelman. He grew up in Queens where he attended Forest Hills High School....
 introduced phacoemulsification in 1967 after being inspired by his dentist's ultrasonic probe.

See also

  • Eye surgery
    Eye surgery

    Eye surgery, also known as orogolomistician surgery or ocular surgery, is surgery performed on the eye or its adnexa, typically by an ophthalmologist....
  • Africa Cataract Project
    Africa Cataract Project

    Africa Cataract Project is a mission of two Turkish NGOs in Africa to give support to prevention of blindness. The project targets 100.000 free cataract surgery in ten African countries which are Sudan, Ethopia, Somalia, Chad, Nijer, Togo, Benin, Gana, Mali and Burkina Faso....


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